Summary
Although the existence of “diabetic cardiopathy” is now undoubted, findings concerning the relationship between the clinical features of diabetes and left ventricular (LV) function are contradictory. The purpose of the present study was to investigate the influence of specific diabetic complications, consisting of retinopathy, nephropathy, and autonomic neuropathy, on LV function in a representative sample of 117 carefully selected young cardiac-asymptomatic type 1 (insulin-dependent) diabetics with duration of disease >2 years. As a control group, 54 healthy young subjects were studied. The diabetic complications were graded by a diabetic complication index (DCI). The diabetics were divided into three groups: those without complications (n = 46), those with mild complications (n = 39), and those with severe complications (n = 32). The LV function was assessed by M-mode echocardiography. A significant correlation between DCI and isovolumic relaxation time (r = 0.76), left atrium emptying index (r = −0.69), fractional shortening (r = −0.62), and ejection fraction (r = −0.60) was found. Diabetics with mild complications had diastolic abnormalities intermediate between those in patients free of complications and those with severe ones, but all their diastolic parameters were abnormal compared with control values. The systolic function in this mild complications group was normal. Diabetics with severe complications had the most pronounced diastolic dysfunction. All their systolic parameters were abnormal, indicating a contractile dysfunction. Most of them had dilated left atria and restricted left ventricles. Systolic dysfunction was found in 39% of the diabetics with complications and in 6% of those free of complications (x 2 = 15.5,P < 0.001). The frequency of diastolic dysfunction was 82% and 33%, respectively (x 2 = 28.6,P < 0.001).
In conclusion, the present findings support the thesis that there is a strong relationship between LV function and diabetic complications in other target organs. The finding that more than half of the patients studied had LV systolic or diastolic dysfunction, even those with relatively low DCI, indicates that LV function abnormalities should be looked for as early as possible in cardiac-asymptomatic diabetics.
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References
Lapa AS, Regan TJ (1992) Direct effects of diabetes on heart muscle. Coronary Artery Dis 3:42–47
Kannel WB, Hjortland M, Castelli WP (1974) Role of diabetes in congestive heart failure: The Framingham study. Am J Cardiol 34:29–34
Raev D, Vakov L (1987) Echocardiographic study of left ventricular compliance in young type 1 diabetics (in Bulgarian). In: XL Conference of Cardiology, Stara Zagora, 2–3 October, 1987, Stara Zagora (Bulgaria) 13:145–151
Airaksinen KEJ, Koistinen MJ, Ikaheimo MJ, Huikuri HV, Korhonen U, Pirttiaho H, Linnaluoto MK, Takkunen JT (1989) Augementation of atrial contribution to left ventricular filling in IDDM subjects as assessed by Doppler echocardiography. Diabetes Care 12:159–161
Kahn JK, Zola B, Juni JE, Vinik AI (1986) Radionuclide assessment of left ventricular diastolic filling in diabetes mellitus with and without cardiac autonomic neuropathy. J Am Coll Cardiol 7:1303–1309
Mustonen J, Uusitupa M, Tahvanainen K, Talwar S, Laakso M, Pyorala K, Lansimies E, Kuikka J (1989) Impaired left ventricular systolic function during exercise in middle-aged insulin-dependent and non-insulindependent diabetic subjects without clinically evident cardiovascular disease. Am J Cardiol 62:1273–1279
Shapiro LM, Leatherdale BA, Mackinnon J, Fletcher RF (1981) Left ventricular function in diabetes mellitus. II: Relation between clinical features and left ventricular function. Br Heart J 45:129–132
Shapiro LM (1982) Echocardiographic features of impaired ventricular function in diabetes mellitus. Br Heart J 47:439–444
Zola B, Kahn JK, Juni JE, Vinik AI (1986) Abnormal cardiac function in diabetic patients with autonomic neuropathy in the absence of ischemic heart disease. J Clin Endocrinol Metab 63:208–214
Cooper KH (1982) The aerobics program for total wellbeing. Bantam Toronto
Rose GA, Blackburn H, Gillium R (1984) Epidemiologic methods for studies of cardiovascular disease, 2nd edn. WHO, Geneva
Raev D, Vakov L (1993) Increased myocardial contractility in young newly-diagnosed type 1 (insulin-dependent) diabetics free of diabetic complications: An echocardiographic study. Am J Noninvasive Cardiol 7:57–62
Michaelis D, Rjasanowski I, Bombor H (1982) Die Beurteilung des Stoffwechselkompensationgrades beim Diabetes Mellitus Mittels des Glykemiewertes. Deutsch Gesundh Wes 37:634–639
Raev D (1992) Left ventricular function in young cardiacasympthomatic type 1 (insulin-dependent) diabetics. Academic dissertation (in Bulgarian). Stara Zagora Medical Institute, Stara Zagora
O'Brien IAD, O'Hare P, Corrall RJM (1986) Heart rate variability in healthy subjects: Effects of age and the derivation of normal ranges for tests of autonomic function. Br Heart J 55:348–354
Ewing DJ, Martyn CN, Young RJ, Clarke BF (1985) The value of cardiovascular autonomic function tests: 10 Years experience in diabetes. Diabetes Care 8:491–498
Ewing DJ, Campbell IW, Clarke BF (1981) Heart rate changes in diabetes mellitus. Lancet I:183–186
Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: Results of survey of echocardiographic measurements. Circulation 58:1072–1083
Teichholz LE, Kreulen T, Herman MV, Gorlin R (1976) Problems in echocardiographic volume determinations: Echocardiographic-angiographic correlations in the presence or absaence of asynergy. Am J Cardiol 37:7–13
Feigenbaum H (1984) Echocardiography, 4th edn. Lea and Febiger, Philadelphia
Devereux RB, Reichek N (1977) Echocardiographic determination of left ventricular mass in man: Anatomic validation of the method. Circulation 55:613–618.
Reichek N, Wilson J, St John Sutton MG, Plappert TA, Goldberg S, Hirshfeld JW (1982) Noninvasive determination of left ventricular end-systolic stress: Validation of the method and initial application. Circulation 65:99–108.
Gaasch WH (1979) Left ventricular to wall thickness ratio. Am J Cardiol 43:1189–1194
Strunk BL, London EJ, Fitzgerald J, Popp RL, Barry WH (1977) The assessment of mitral stenosis and prosthetic mitral valve obstruction, using the posterior aortic wall echocardiogram. Circulation 55:885–891.
Dalla-Volta S, Razzolini R, Scognamiglio R, Rubino A, Chioin R (1988) Myocardial function in heart failure. Cardiology 75 [Suppl 1]:8–18
Factor SM, Okun EM, Minase T (1980) Capillary microaneurisms in the human diabetic heart. New Engl J Med 302:384–388
Regan TJ, Haider B, Lyons MM (1978) Altered ventricular function and metabolism in diabetes mellitus. In: Zoneraich S (ed) Diabetes and the heart. Charles C Thomas, Springfield, pp 123–136
Ganguly PK, Pierce GN, Dhalla KS, Dhalla NS (1983) Defective sarcoplasmic reticular calcium transport in diabetic cardiomyopathy. Am J Physiol 244:E528-E534.
Ruddy TD, Shumak SL, Luis PP, Barnie A, Seawright SJ, McLaughlin PR, Zinman B (1988) The relationship of cardiac diastolic dysfunction to concurrent hormonal and metabolic status in type 1 diabetes mellitus. J Clin Endocrinol Metab 66:113–118
Danielsen R, Nordrehaug JE, Lien E, Vik-Mo H (1987) Subclinical left ventricular abnormalities in young subjects with long-term type 1 diabetes mellitus detected by digitized M-mode echocardiography. Am J Cardiol 60:143–146.
Zarich SW, Arbuckle BE, Cohen LR, Roberts M, Nesto RW (1988) Diastolic abnormalities in young asymptomatic diabetic patients assessed by pulsed Doppler echocardiography. J Am Coll Cardiol 12:114–120.
Jenkins JG, Carson DJ, McClure BG, Sharif B, McCready P, Mitchell RH (1989) Heart rate variability in young diabetics. In: Laron Z, Karp M (eds) Prognosis of diabetes in children. Pediatric Adolescent Endocrinology, vol. 18. Karger, Basel, pp 42–46
American Diabetes Association and American Academy of Neurology (1988) Consensus statement: Report and recommendations of the San Antonio conference on diabetic neuropathy. Diabetes Care 11:592–597.
Borch-Johnsen K, Kreiner S (1987) Proteinuria: Value as predictor of cardiovascular mortality in insulindependent diabetes mellitus. Br Med J 294:1651–1654
Zola BE, Vinik AI (1992) Effects of autonomic neuropathy associated with diabetes mellitus on cardiovascular function. Coronary Artery Dis 3:33–41
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Raev, D.C. Left ventricular function and specific diabetic complications in other target organs in young insulin-dependent diabetics: An echocardiographic study. Heart Vessels 9, 121–128 (1994). https://doi.org/10.1007/BF01745237
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DOI: https://doi.org/10.1007/BF01745237