[Exploration of left ventricular function in insulin-dependent diabetics (relation with retinopathy)]

Non invasive methods for the exploration of myocardial function permit the demonstration of preclinical diabetic cardiomyopathy. In this study, we have tried to define the relationship between the degree of diabetic retinopathy and the presence of myocardial dysfunction. We have recorded echocardiogram and phonomechanograms on thirty two insulin dependent diabetics (IDD) less than 50 years of age, without evidence of arteriosclerosis. All patients had a normal baseline electrocardiogram and a normal bicycle exercise test. These diabetics were assigned to three groups: I = no retinopathy (9 patients); II = minimum retinopathy (12 patients); III = marked retinopathy (11 patients). They were compared to ten non-diabetic control subjects of similar age (group 0). None of the parameters of systolic function was modified in the different groups of diabetics in comparison with the control group. We found, however, a very significant reduction of the maximum rate of enlargement of left ventricule and reduction of the maximum narrowing rate of the left ventricular posterior wall during the protodiastolic period in group III, v.s. group 0, I and II. Group III contained 3 patients with borderline hypertension and 5 patients with diabetic glomerulopathy. Our results indicate a diminution of myocardial compliance and relaxation in those IDD with marked retinopathy, but it raises the question of the role of borderline elevations of arterial pressure or hypertension during physical exercise, which are frequently found in diabetics with retinopathy in causing these abnormalities.