Right Ventricular Involvement in Diabetic Cardiomyopathy

Abstract

OBJECTIVETo compare magnetic resonance imaging-derived right ventricular (RV) dimensions and function between men with type 2 diabetes and healthy subjects, and to relate these parameters to left ventricular (LV) dimensions and function.RESEARCH DESIGN AND METHODSRV and LV volumes and functions were assessed in 78 men with uncomplicated type 2 diabetes and 28 healthy men within the same range of age using magnetic resonance imaging. Steady-state free precession sequences were used to assess ventricular dimensions. Flow velocity mapping across the pulmonary valve and tricuspid valve was used to assess RV outflow and diastolic filling patterns, respectively. Univariate general linear models were used for statistical analyses.RESULTSRV end-diastolic volume was significantly decreased in patients compared with healthy subjects after adjustment for BMI and pulse pressure (177 ± 28 mL vs. 197 ± 47 mL, P < 0.01). RV systolic function was impaired: peak ejection rate across the pulmonary valve was decreased (433 ± 54 mL/s vs. 463 ± 71 mL/s, P < 0.01) and pulmonary flow acceleration time was longer (124 ± 17 ms vs. 115 ± 25 ms, P < 0.05). Indexes of RV diastolic function were impaired: peak filling rate and peak deceleration gradient of the early filling phase were 315 ± 63 mL/s vs. 356 ± 90 mL/s (P < 0.01) and 2.3 ± 0.8 mL/s2 × 10−3 vs. 2.8 ± 0.8 mL/s2 × 10−3 (P < 0.01), respectively. All RV parameters were strongly associated with its corresponding LV parameter (P < 0.001).CONCLUSIONSDiabetic cardiomyopathy affects the right ventricle, as demonstrated by RV remodeling and impaired systolic and diastolic functions in men with type 2 diabetes, in a similar manner as changes in LV dimensions and functions. These observations suggest that RV impairment might be a component of the diabetic cardiomyopathy phenotype.

Cardiac Structure and Function Across the Glycemic Spectrum in Elderly Men and Women Free of Prevalent Heart Disease

“…The association between HbA1c and right ventricular function was also not significant in adjusted analyses. While a handful of small studies have shown right ventricular impairments associated with diabetes 41-43 , there is, however, little data about the prognostic value of RV function in a non-disease state and its relationship with HF incidence. Although RV fractional area change is a validated measure of RV systolic function that has been correlated with MRI derived ejection fraction 44,45 and associated with clinical outcomes 46 , it is possible that subclinical impairments in RV function related to dysglycemia cannot be captured by RV fractional area change measurement and may explain the lack of association in our analyses.…”

Effects of Short-Term Nutritional Interventions on Right Ventricular Function in Healthy Men

“…After indexing for body surface area, RV EDVI was significantly lower. Decreased RV volumes and impaired RV function have also been implicated as components of the diabetic cardiomyopathy phenotype [11]. …”

“…In short, RV dimensions and systolic function were assessed by imaging the entire heart in short-axis orientation using electrocardiographically gated breath-hold balanced steady-state free precession imaging. Endocardial contours of the RV were manually drawn in end-diastolic phase and end-systolic phase as previously described [11]. Imaging parameters were as follows: repetition time (TR)=3.3 ms, echo time (TE)=1.67 ms, flip-angle=35°, slice thickness=10 mm, slice gap=0 mm, field of view=400 x 400 mm, reconstructed matrix size=256x 256.…”

“…Advanced RV dysfunction and fibrosis are associated with exercise limitation, lethal ventricular arrhythmias, sudden death, and reduced RV cardiac output [8,9]. Moreover, it has been shown that RV dimensions and function are impaired in type 2 diabetes [10,11], a disease with abnormal fuel flux and energy imbalance as metabolic hallmarks.…”

Diastolic function of the right ventricle is impaired in experimental type 2 diabetic rat models

“…with diabetes, and in these studies, some reported that cardiac diastolic dysfunction represents an early stage of myocardial damage in patients with diabetes, without any clinical manifestations (8,9). Although RV dysfunction has not been paid due attention in the past, in recent years, researchers have gradually realized that RV dysfunction is relevant and is an independent predictor in a variety of disease states (13,14). Van den Brom reported RV systolic dysfunction in Zucker diabetic fatty rats (15).…”