[Abnormal left ventricular function in diabetic patients, with special reference to abnormal diastolic function....

In order to elucidate the nature of cardiovascular involvement in diabetes mellitus (DM), we analyzed a high-resolution time-activity cure obtained from a gated equilibrium radionuclide left ventriculography (RLVG) in 50 cases consisting of 3 groups; G-C: normal controls (n = 17, male 10 and female 7, age 49.6 +/- 9.6 years old), G-DM: patients with DM without clinical signs of ischemic heart disease (n = 17, male 13 and female 4, age 58.3 +/- 9.9 years old), and G-DM + MI: patients with DM complicated myocardial infarction (n = 16, male 14 and female 2, age 59.5 +/- 10.0 years old). Indexes of cardiac performance during both systole and diastole obtained from RLVG were as follows: ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR), time from the start of systole to PER (T-PER1), time from end-systole to PFR (T-PFR2), diastolic relaxation rate (DRR) during the first third of diastole (DRRe) and during the whole diastole (DRRt). There were no significant differences in EF and PER (systolic parameters) between G-C and G-DM. These parameters were significantly lower only in G-DM +/- MI. However, DRRe and DRRt (diastolic parameters) were significantly smaller, and T-PFR1 and T-PFR2 were longer in G-DM and G-DM + MI than in G-C. PFR was significantly lower in G-DM + MI than in the other two groups and there was no significant difference between G-DM and G-C. In addition, DRRe was significantly lower in patients with retinopathy than in patients without retinopathy in both G-DM and G-DM + MI. It is concluded that DM can cause impairment of diastolic relaxation of the left ventricle before the appearance of distinct cardiac dysfunction during systole and that it might be probably due to microangiopathy. These results suggest a poor prognosis of MI in patients with DM.