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Improved metabolic control does not reverse left ventricular filling abnormalities in newly diagnosed
1Department of Endocrinology, Zvezdara University Medical Centre, Belgrade, Yugoslavia.
Insights
Newly diagnosed diabetes impairs left ventricular diastolic function, characterized by abnormal filling patterns. This dysfunction persists despite improved glycemic control, indicating a need for early intervention in diabetic patients.
Area of Science:
- Cardiology
- Endocrinology
- Diabetology
Background:
- Type 2 diabetes mellitus (T2DM) is associated with cardiovascular complications.
- Diastolic dysfunction is an early indicator of cardiac impairment in various conditions.
Purpose of the Study:
- To evaluate left ventricular diastolic function in newly diagnosed T2DM patients.
- To assess the impact of glycemic control on diastolic function over 12 months.
Main Methods:
- Doppler echocardiography was used to assess diastolic function parameters.
- Measurements included mitral flow velocities (E, A), A/E ratio, and filling durations (Ei, Ai).
- Glycosylated hemoglobin A1C, lipids, and anthropometrics were monitored in patients and controls.
Main Results:
- Diabetic patients exhibited impaired diastolic function, with shorter early filling duration (Ei) and higher A wave velocity and A/E ratio.
- These abnormalities were present at diagnosis and persisted after 12 months of glycemic control.
- Elevated total cholesterol and triglyceride levels were observed in diabetic patients and remained high throughout the study.
Conclusions:
- Newly diagnosed T2DM is associated with significant left ventricular diastolic dysfunction.
- Improved glycemic control alone does not reverse these cardiac abnormalities.
- Early detection and management of cardiac involvement in T2DM are crucial.
Abstract:
In this study left ventricular diastolic function at rest was evaluated in ten newly diagnosed, non-insulin-dependent diabetic patients by Doppler echocardiography, performed at the onset of disease and after 6 and 12 months of adequate glycaemic control. Glycosylated haemoglobin A1C, total cholesterol and triglyceride levels were assessed at the same time. The control group consisted of ten healthy subjects of matching age and body mass index. The following parameters of left ventricular function were evaluated: ejection fraction (EF), peak velocity of the early (E) and late atrial (A) mitral flow, A/E ratio, duration of the early (Ei) and of the atrial (Ai) filling phase, and heart rate. The diabetic patients had significantly higher total cholesterol and triglyceride levels compared with healthy subjects. These remained elevated throughout the follow-up period, in spite of improved glycaemic control. A significantly shorter duration of Ei (0.15 +/- 0.008 vs 0.18 +/- 0.004, P < 0.01) and a higher value of A (0.51 +/- 0.02 vs 0.39 +/- 0.01, P < 0.001) and A/E (1.06 +/- 0.05 vs 0.73 +/- 0.02, P < 0.001) were found in the diabetic patients before treatment. The parameters did not significantly change after 1 year of adequate glycaemic control. These results indicate a left ventricular filling abnormality which is present in newly diagnosed non-insulin-dependent diabetic patients and does not reverse with improved glycaemic control.