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Isolated Type 2 Diabetes mellitus Causes Myocardial Dysfunction That Becomes Worse in the Presence of Cardiovascular Diseases: Results of the Myocardial Doppler in Diabetes (MYDID): Study 1
BMJ Heart Center, Bangalore, India.
Department of Clinical Physiology, Karolinska University Hospital at Huddinge, Stockholm, Sweden.
Department of Clinical Physiology, Karolinska University Hospital at Huddinge, Stockholm, Sweden.
Department of Clinical Physiology, Karolinska University Hospital at Huddinge, Stockholm, Sweden.
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2005 (English)In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 103, no 4, 189-195 p.Article in journal (Refereed) Published
Abstract [en]

Aims: Patients with type 2 diabetes mellitus (DM) often suffer disproportionately and have a worse outcome when burdened with cardiovascular complications compared with those without DM. A specific heart muscle disease reportedly caused by DM per se may explain this. We sought to investigate whether an echo Doppler diagnosis of such a myocardial disease is clinically relevant in DM with or without coexistent coronary artery disease (CAD) and/or hypertension ( HTN). Subjects and Methods: Two hundred subjects (127 males, 73 females, 56 +/- 10 years) including controls (n=23), patients with HTN (n=20), CAD (n=35), uncomplicated DM (n=59), DM+HTN (n=27), DM+ CAD (n=16) and DM+CAD+HTN (n=20) underwent tissue Doppler-enhanced dobutamine stress echocardiography. Myocardial function was assessed by measuring left ventricular myocardial peak systolic velocity (PSV) and early diastolic velocity at rest and during peak stress, besides measurements of standard Doppler variables. Results: Average left ventricular PSV at rest was significantly lower in CAD (4.7 +/- 1.5) compared with controls (5.7 center dot +/- 1.2) and in DM+CAD+HTN (4.6 +/- 1.4) compared with DM (5.6 +/- 1.3; all p < 0.05). During peak stress, lower PSV persisted in CAD (9.5 +/- 3.1) and DM+CAD+HTN (8.1 +/- 2.7), while appearing de novo in DM (11.3 +/- 2.6) and HTN (11.0 +/- 2.3) unlike in the controls (12.5 +/- 2.5; all p < 0.001). When pooled together, DM subjects with CAD and/or HTN or both had significantly lower PSV (9.1 +/- 2.7) than those without (10.0 +/- 2.8; p < 0.001). Early diastolic velocity response was equally lower in both groups compared with the controls. Conclusion: The results suggest that dobutamine stress unmasks myocardial functional disturbances caused by uncomplicated DM. The discrete disturbances become quantitatively more pronounced in the presence of coexistent cardiovascular diseases.

Place, publisher, year, edition, pages
2005. Vol. 103, no 4, 189-195 p.
Keyword [en]
type 2 diabetes; myocardial velocity; coronary artery disease; dobutamine stress echocardiography
National Category
Medical Laboratory and Measurements Technologies Endocrinology and Diabetes Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:kth:diva-7055DOI: 10.1159/000085126ISI: 000229814800005OAI: oai:DiVA.org:kth-7055DiVA: diva2:11948
Note
QC 20100709Available from: 2007-05-08 Created: 2007-05-08 Last updated: 2012-03-23Bibliographically approved
In thesis
1. Myocardial Effects of Type 2 Diabetes, Co-morbidities, and Changing Loading Conditions: a Clinical Study by Tissue Velocity Echocardiography
Open this publication in new window or tab >>Myocardial Effects of Type 2 Diabetes, Co-morbidities, and Changing Loading Conditions: a Clinical Study by Tissue Velocity Echocardiography
2007 (English)Doctoral thesis, comprehensive summary (Other scientific)
Abstract [en]

Ever since the validation of the tissue velocity echocardiography (TVE) technique more than a decade ago the modality has been used rather successfully in various clinical situations, at rest as well as during stress echocardiography. Hitherto, dobutamine stress echocardiography has been the hallmark of all forms of stress procedures, now with TVE, quantification of the longitudinal motions of the left ventricle shows far superiority, with improved sensitivity and specificity in the functional diagnosis of coronary artery disease. Morever there has been continued interest in this technique for even assessing subclinical myocardial systolic and diastolic function in clinical scenarios like diabetes, hypertension and chronic kidney disease.

The aim of the present study was to evaluate left ventricular myocardial functions by applying TVE in human subjects having type 2 diabetes with or without co-morbidities and during changing loading conditions. The effects of changing loading conditions were analyzed during hemodialysis and following oral administration of an AT1 receptor blocker. The studied subjects included individuals with diabetes as well as those with associated hypertension, coronary artery disease, microalbuminuria and end-stage renal disease. All patients with type 2 diabetes and co-morbidities underwent TVE enhanced dobutamine stress echocardiography while load dependant left ventricular functions were analyzed at rest. There were 270 subjects in the study of type 2 diabetes and associated cardiovascular diseases and 101 subjects in the study of changing loading conditions.

Patients with type 2 diabetes revealed subclinical left ventricular dysfunction characterized by reduced functional reserve. This influence becomes quantitatively more pronounced in the presence of coexistent coronary artery disease and hypertension. The coexistence of type 2 diabetes and hypertension appears to have additive negative effect on both systolic and diastolic left ventricular function, even in the absence of coronary artery disease. The presence of microalbuminuria in type 2 diabetes patients does not worsen diminished myocardial functional reserve. A single session of hemodialysis improves left ventricular function in patients with end-stage renal disease only in the absence of type 2 diabetes and co-morbidities, while a single dose of an AT1 receptor blocker valsartan results in reduction of afterload and, subsequently, in improvement of left ventricular function. TVE appears to be a sensitive tool for objective assessment of left ventricular function and can be successfully applied for the clinical evaluation of the effect of type 2 diabetes and co-morbidities on myocardial performance.

Place, publisher, year, edition, pages
Stockholm: KTH, 2007. 74 p.
Series
Trita-STH : report, ISSN 1653-3836 ; 2007:2
National Category
Biomedical Laboratory Science/Technology
Identifiers
urn:nbn:se:kth:diva-4359 (URN)978-91-7178-647-0 (ISBN)
Public defence
2007-05-25, Plan 4, Novum Research Park, Flemingsberg, 09:00
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Note
QC 20100709Available from: 2007-05-08 Created: 2007-05-08 Last updated: 2010-10-01Bibliographically approved

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