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[Early decrease in diastolic function in young type I diabetic patients as an initial manifestation of diabetic
C M Schannwell1, F C Schoebel, S Heggen
1Medizinische Klinik, Heinrich-Heine-Universität Düsseldorf.
Insights
Young patients with insulin-dependent diabetes mellitus (IDDM) exhibit diastolic dysfunction, even with normal systolic function. Echocardiography can detect this early sign of diabetic cardiomyopathy.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Background:
- Myocardial manifestation in insulin-dependent diabetes mellitus (IDDM) is crucial for prognosis.
- Diabetic cardiac complications often mask early myocardial changes.
- Early detection of cardiac issues in young IDDM patients is vital.
Purpose of the Study:
- To investigate diastolic left ventricular (LV) dysfunction in young, asymptomatic IDDM patients.
- To determine if normal systolic LV function in IDDM patients coexists with diastolic dysfunction.
- To identify early cardiac manifestations in IDDM.
Main Methods:
- Echocardiography performed on 92 IDDM patients and 50 controls.
- M-mode echocardiography for morphological and systolic parameters (ejection fraction).
- Doppler indices measured: diastolic flow velocities (VE, VA), E/A ratio, deceleration time (DT), isovolumetric relaxation time (IVRT).
Main Results:
- IDDM patients showed normal LV dimensions and systolic function.
- Significant diastolic dysfunction observed: reduced early diastolic filling (VE) and E/A ratio.
- Increased atrial filling (VA), prolonged IVRT, and extended DT in IDDM patients.
Conclusions:
- Young IDDM patients with normal systolic function exhibit diastolic dysfunction.
- Diastolic dysfunction serves as an early marker for diabetic cardiomyopathy.
- Echocardiography is a valuable tool for monitoring diabetic cardiomyopathy progression.
Introduction:
The early determination of the myocardial manifestation is of considerable importance, since the prognosis of patients (P) with insulin dependent diabetes mellitus (IDDM) is generally masked by secondary cardiac complications. The aim of this study was to investigate whether young, asymptomatic P with IDDM and persisting normal systolic left ventricular (LV) function already show a diastolic LV dysfunction.
Methods:
An echocardiographical examination of 92 IDDM patients (age: 25 +/- 4 years) without known cardiac disease and of 50 control persons (C) of similar ages was carried out. P with a cardiac disease or long-term diabetic syndrome were excluded. Using M-mode echocardiography, morphological parameters and systolic time-intervals (fractional shortening; ejection fraction) were determined. Doppler indices were then measured: maximal early and late diastolic flow velocity (VE; VA), E/A ratio, acceleration and deceleration time (DT), isovolumetric relaxation time (IVRT).
Results:
Although the left atrial and left ventricular dimensions, as well as the systolic functional parameters of all P with IDDM were normal, they showed a diastolic dysfunction with a reduction of the early diastolic filling (VE; 0.54 +/- 0.07 m/s vs 0.72 +/- 0.04 m/s; p < 0.01) and the E/A ratio (0.9 +/- 0.15 vs 1.99 +/- 0.22; p < 0.01), an increase in the atrial filling (VA; 0.76 +/- 0.05 m/s vs 0.39 +/- 0.04 m/s, p < 0.01), an extension of the IVRT (129 +/- 23 ms vs 78 +/- 6 ms, p < 0.01), and an increased DT (248 +/- 27 ms vs 188 +/- 8 ms, p < 0.01).
Conclusion:
Even young P with IDDM, with a normal systolic ventricular function, suffer a diastolic dysfunction which serves as a marker of a diabetic cardiomyopathy. Therefore, echocardiography with measurements of systolic and diastolic functional parameters appears to be a sensible method for evaluating the course of diabetic cardiomyopathy.