MiscellaneousUsefulness of At Rest and Exercise Hemodynamics to Detect Subclinical Myocardial Disease in Type 2 Diabetes Mellitus
Section snippets
Methods
A total of 167 apparently healthy subjects with T2DM (97 men, 55 ± 10 years) and no macro- or microvascular complications of T2DM or history of hypertension or valvular, congenital, or ischemic heart disease were recruited from the hospital clinics of the Princess Alexandra Hospital and its local community. Sinus rhythm and normal renal function were required for inclusion. Antihypertensive medications were withheld for ≥12 hours before testing. The human research ethics committees of Princess
Results
All 167 subjects had an ejection fraction at rest of >50% and no evidence of inducible ischemia on the exercise stress echocardiogram. Sinus rhythm was maintained throughout testing in all participants. At baseline, 24 subjects had subclinical dysfunction as shown by a reduced at rest Em (septal Em <2 SD of normal for age). Differences were noted between the metabolic parameters of those with abnormal findings and the 143 subjects with normal at rest myocardial function (Table 1). The subjects
Discussion
The intensity of metabolic disturbances in those with T2DM has been associated with subclinical myocardial dysfunction for both diastolic and systolic parameters at rest but was unrelated to the stress response. Instead, abnormal stress responses appear to be associated with myocardial properties consistent with structural change. Diabetic heart disease is characterized by myocardial collagen deposition and myofibrillar hypertrophy in the absence of valvular, congenital, hypertensive, or
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This study was supported in part by a Centres for Clinical Research Excellence award (455832) from the National Health and Medical Research Council, Canberra, Australia. Dr. Jellis was supported by a Research Entry Scholarship from the Vincent Fairfax Family Foundation, Sydney, Australia; and the Royal Australasian College of Physicians, Sydney, Australia.