Left ventricular diastolic filling in type I diabetes mellitus: a pulsed Doppler echocardiographic study

Doppler echocardiography was used to assess left ventricular diastolic performance in young patients with type I diabetes mellitus and no clinical signs of heart disease.

The pattern of transmitral diastolic flow velocity was determined in 82 patients (56 men, 26 women; age 17.7 +/- 7.6) with type I diabetes mellitus and no heart disease. Maximal early diastolic flow velocity (E peak), maximal late diastolic velocity (A peak), the ratio of maximal flow velocity in late diastole to that in early diastole (A/E ratio) and the ratio of the time velocity integral of the diastole (1/3 FF) were measured in all 82 patients and repeated during exercise in 63 of them. Twenty healthy volunteers served as controls.

Mean values of the Doppler indexes were not significantly different between the patients and the 20 controls, but diabetic patients with microvascular complications showed patterns of left ventricular diastolic flow velocity which suggested altered diastolic performance, namely lower E peak velocity, higher A peak velocity, raised A/E ratio and reduced 1/3 FF. Among the 63 examined during exercise, different diastolic flow patterns in response to effort made it possible to identify 15 patients with a high rate of autonomic dysfunction, indicating probable impairment of diastolic function and a need for close follow-up.

Diastolic abnormalities may occur in young diabetic patients without evidence of heart disease and suggest Doppler evaluation is a sensitive method for identifying patients at potential risk of developing clinical heart disease.