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Asymptomatic diabetic cardiomyopathy: a noninvasive study
J R Attali1, R N Sachs, P Valensi
1Department of Diabetology, Hôpital Avicenne, Bobigny, France.
Insights
Diabetic patients show early left ventricular (LV) dysfunction, including impaired relaxation and contractility, even without heart disease. This suggests a metabolic cause, not microangiopathy, in asymptomatic individuals.
Area of Science:
- Cardiology
- Diabetology
- Biomedical Engineering
Background:
- Diabetes mellitus is a global health concern.
- Diabetic patients are at increased risk for cardiovascular complications.
- Early detection of cardiac dysfunction in diabetes is crucial.
Purpose of the Study:
- To investigate left ventricular (LV) function in asymptomatic diabetic patients.
- To differentiate diabetic cardiomyopathy from other cardiac conditions.
- To identify early markers of LV dysfunction in diabetes.
Main Methods:
- Noninvasive assessment of LV function in 49 diabetic patients and 32 controls.
- Utilized M-mode echocardiography, phonomechanography, and radionuclide angiocardiography.
- Confirmed absence of ischemic heart disease via ECG and thallium-201 scintigraphy.
Main Results:
- Diabetic patients exhibited prolonged isovolumetric relaxation time (IVRT) and reduced E-F slope, indicating increased myocardial stiffness and impaired LV compliance.
- An increased Weissler index (pre-ejection period/LV ejection time) suggested impaired myocardial contractility.
- These abnormalities were present early in diabetes, often within 5 years, and unrelated to complications, sex, or age.
- No significant differences were observed in LV dimensions, wall thickness, or ejection fraction between groups.
Conclusions:
- Diabetes is associated with specific, early-onset left ventricular (LV) dysfunction, independent of ischemic heart disease or hypertension.
- Metabolic factors, rather than microangiopathy, are likely involved in this early, asymptomatic LV abnormality.
- Findings highlight the need for monitoring cardiac function in diabetic patients from diagnosis.
Abstract:
Forty-nine diabetic patients (26 type I and 23 type II), free of cardiovascular disease symptoms, were compared with 32 controls in a noninvasive study of left ventricular (LV) function. Absence of ischemic cardiopathy was confirmed by routine investigations and an exercise electrocardiogram using 12 leads with a thallium-201 myocardial scintigraphy. Diabetic patients had (1) a significantly prolonged mean isovolumetric relaxation time (IVRT) assessed by M-mode echocardiography and phonomechanography; (2) a significantly reduced E-F slope; (3) an increased mean Weissler index (pre-ejection period/LV ejection time). The IVRT and E-F slope abnormalities reflect increased myocardial stiffness and impaired LV compliance. The increased Weissler index reflects impaired myocardial contractility. These abnormalities were not related to sex, age, duration of diabetes or to the presence or extent of complications. No significant difference was found between diabetic patients and controls for mean diastolic and systolic LV diameters, thickness of the posterior wall or of the interventricular septum, assessed by echocardiography, or for the ejection fraction, determined by radionuclide angiocardiography. Finally, more than half of the patients with a frankly abnormal IVRT, Weissler index and E-F slope had had diabetes for less than 5 years, some even less than 2 years, without complications. These data show: (1) evidence of LV dysfunction specific to diabetes and unrelated to ischemic cardiopathy and hypertension; (2) the possible involvement of a metabolic factor in this early asymptomatic LV abnormality rather than microangiopathy.