Diastolic Dysfunction in Patients with Type 2 Diabetes Mellitus: Is It Really the First Marker of Diabetic Cardiomyopathy?

doi:10.1016/j.echo.2011.07.017

Journal of the American Society of Echocardiography

Volume 24, Issue 11, November 2011, Pages 1268-1275.e1

https://doi.org/10.1016/j.echo.2011.07.017 Get rights and content

Background

Diastolic dysfunction is considered the first marker of diabetic cardiomyopathy. However, preclinical systolic alteration was also recently described by strain, but its association with diastolic dysfunction has never been investigated.

Methods

One hundred fourteen patients with type 2 diabetes mellitus (DM) with controlled blood pressure and without overt heart disease were prospectively enrolled and compared with 88 age-matched controls. All subjects underwent comprehensive echocardiography, including diastolic evaluation according to current recommendations and speckle-tracking imaging. The prevalence of diastolic dysfunction, the determinants of diastolic parameters, and the association between preclinical systolic and diastolic dysfunctions were studied.

Results

Diastolic parameters were altered in patients compared with controls, with lower E/A ratios, longer mitral deceleration and isovolumic relaxation times, and higher E/e′ ratio. Diastolic dysfunction occurred in 47% of patients with DM (33% and 14% with grade I and II diastolic dysfunction, respectively) and systolic alteration (longitudinal strain ≥ −18%) in 32% of patients. Whereas longitudinal systolic strain was independently associated with DM and gender, diastolic parameters were influenced by many factors, including age, rate-pressure product, history of hypertension, and body mass index. Systolic alteration occurred in 28% of patients with DM with normal diastolic function and in 35% with diastolic dysfunction.

Conclusions

Diastolic dysfunction diagnosed according to current recommendations is frequent in patients with DM but is also influenced by other factors. Systolic strain alteration may exist despite normal diastolic function, indicating that diastolic dysfunction should not be considered the first marker of a preclinical form of diabetic cardiomyopathy.

Section snippets

Study Population

A total of 114 consecutive patients with type 2 DM referred to our institution (Louis Pradel Hospital, Lyon, France) between February 2006 and March 2008 were prospectively recruited and described in a previous report regarding radial and longitudinal function.¹⁹ In the present study, we specifically focused on diastolic function and its relation with systolic function in the same patients and controls.

The recruitment of patients with DM was based on referral to the outpatient clinical

Results

Table 1 displays the characteristics of the study population. Patients with DM had normal but higher blood pressure than controls and presented higher heart rates and rate-pressure products. In addition, patients with DM had normal conventional parameters of systolic function including LVEF, and a normal LVM index, compared with controls. However, on the basis of systolic strains, the prevalence of radial and longitudinal systolic dysfunction among patients with DM as 38% (43 of 114 patients)

Discussion

Our study adds important new insights into the early detection of diabetic cardiomyopathy. Indeed, diabetic cardiomyopathy is currently defined as diastolic dysfunction.2, 3, 4 However, our group and others have also shown systolic strain abnormalities in patients with DM.16, 17, 19, 27 This study is the first to show that systolic strain alteration may exist despite normal diastolic function, indicating that diastolic dysfunction should not be considered the first marker of a preclinical form

Conclusions

Diastolic dysfunction diagnosed according to the current recommendations is frequent in patients with DM but is also influenced by other factors, such as age, rate-pressure product, LVM index, and BMI. Systolic strain alteration is associated only with DM and gender and may exist despite normal diastolic function, indicating that diastolic dysfunction should not be considered the first marker of a preclinical form of diabetic cardiomyopathy. Therefore, systolic strain abnormality might be

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: This study was supported by the Association of French Language for the Study of Diabetes Mellitus and Metabolic Diseases (D20515) and by Fonds voor Wetenschappelijk Onderzoek Vlaanderen research grant G.0838.10 (to the Asklepios study).

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Clinical InvestigationSystemic Disorders Affecting Cardiac FunctionDiastolic Dysfunction in Patients with Type 2 Diabetes Mellitus: Is It Really the First Marker of Diabetic Cardiomyopathy?

Background

Methods

Results

Conclusions

Section snippets

Study Population

Results

Discussion

Conclusions

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

J Am Soc Echocardiogr

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Coll Cardiol

Am Heart J

J Am Coll Cardiol

Clinical Investigation
Systemic Disorders Affecting Cardiac Function
Diastolic Dysfunction in Patients with Type 2 Diabetes Mellitus: Is It Really the First Marker of Diabetic Cardiomyopathy?