Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Impaired Myocardial Functional Reserve in Hypertension and Diabetes Mellitus Without Coronary Artery Disease: Searching for the Possible Link With Congestive Heart Failure in the Myocardial Doppler in Diabetes (MYDID) Study II
Department of Clinical Physiology, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Department of Clinical Physiology, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Department of Clinical Physiology, Karolinska Institute, Karolinska University Hospital, Huddinge.
BMJ Heart Center, Bangalore, India.
Show others and affiliations
2006 (English)In: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1879-1905, Vol. 19, no 8, 851-857 p.Article in journal (Refereed) Published
Abstract [en]

Background: Although the impact of type 2 diabetes mellitus (DM) and hypertension (HTN) on myocardial function has recently been studied using tissue Doppler echocardiography (TDE), the independent role of both conditions, and the influence of other risk factors on myocardial function has not been completely defined, particularly in absence of coronary artery disease (CAD). The aim of this study was to assess the myocardial functional reserve in patients with DM or HTN with apparently normal left ventricular (LV) systolic function.

Methods: Standard and dobutamine stress echocardiography using TDE was performed in 128 subjects: 59 had DM, 20 had HTN, 27 had both DM and HTN (HTN + DM), and 22 subjects were controls (C). Subjects with known CAD and depressed LV function were excluded. In addition, standard two-dimensional and Doppler measurements, LV regional peak systolic (PSV), early (E') and late (A') diastolic velocities, strain (S%) and strain rate (SR), were assessed at rest and peak stress.

Results: The LV mass did not differ, although relative wall thickness was significantly higher in subjects with HTN + DM and HTN. The PSV did not differ at rest but was lowest in subjects with HTN + DM at peak stress. The E' wave velocity was significantly lower in subjects with HTN + DM both at rest and during peak stress, as were S% and SR.

Conclusions: The addition of DM to HTN has a negative effect on LV systolic and diastolic functions. A depressed myocardial functional reserve might be postulated as one of the pathophysiologic mechanisms for the excessive occurrence of congestive heart failure in patients with DM or HTN.

Place, publisher, year, edition, pages
2006. Vol. 19, no 8, 851-857 p.
Keyword [en]
type 2 diabetes mellitus; hypertension; congestive heart failure; left ventricular function; tissue Doppler echocardiography
National Category
Endocrinology and Diabetes Cardiac and Cardiovascular Systems Medical Laboratory and Measurements Technologies
Identifiers
URN: urn:nbn:se:kth:diva-7057DOI: 10.1016/j.amjhyper.2006.01.005ISI: 000240297900014OAI: oai:DiVA.org:kth-7057DiVA: diva2:11950
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
Opponent
Supervisors
Note
QC 20100709Available from: 2007-05-08 Created: 2007-05-08 Last updated: 2010-10-01Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textAmerican Journal of Hypertension

Search in DiVA

By author/editor
Govind, Satish C.Brodin, Lars-Åke
In the same journal
American Journal of Hypertension
Endocrinology and DiabetesCardiac and Cardiovascular SystemsMedical Laboratory and Measurements Technologies

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 84 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf