Variables affecting cardiac output in obesity and diabetes

  • Ralph Abraham
Chapter
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 138)

Abstract

In 1933, Smith and Willius first showed that mean weight of the heart was greater in obese subjects than in normal hearts (376 g versus 272 g) and in those patients that were both obese and hypertensive, the mean weight was even greater at 467 g [1]. The increased heart size associated with human obesity has been attributed to both an increased adiposity of the heart and ventricular hypertrophy [2, 3, 4]. In humans, two distinct patterns of fatty heart have been described. Lipid can accumulate in the cytoplasm [1] and fatty infiltration also occurs with accumulation of adipose tissue in the subepicard-ium and interstitially in the myocardium [1], particularly in the right ventricle and atrioventricular sulci [1, 5].

Keywords

Cardiac Output Left Ventricular Mass Autonomic Neuropathy Left Ventricular Filling Diabetic Cardiomyopathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Smith HL, Willius FA. Adiposity of the heart: a clinical and pathologic study of one hundred and thirty-six obese patients. Arch Intern Med 1933;52:910–931.Google Scholar
  2. 2.
    Alexander JK. Obesity and cardiac performance. Am J Cardiol 1964;14:864–865.Google Scholar
  3. 3.
    Alexander JK. The heart and obesity. In Hurst, JW, Logue RB, Schlant RC et al. The Heart (4th Ed) New York: McGraw-Hill, 1978; 1701–1706.Google Scholar
  4. 4.
    Warnes CA, Roberts WC. The heart in massive (more than 300 pounds or 136 kg) obesity: analysis of 12 patients studied at necropsy. Am J Cardiol 1984;54:1087–1091.PubMedGoogle Scholar
  5. 5.
    Roberts WC, Roberts JD. The floating heart or the heart too fat to sink; an analysis of 55 necropsy patients. Am J Cardiol 1983;52;1286–1289.PubMedGoogle Scholar
  6. 6.
    De Divitis O, Fazio S, Petitto M et al. Obesity and cardiac function. Circulation 1981;64:477–482.Google Scholar
  7. 7.
    Licata G, Scaglione R, Barbagallo M et al. Effect of obesity on left ventricular function studied by radionuclide angiocardiography. Int J Obes 1991;15:295–302.PubMedGoogle Scholar
  8. 8.
    Messerli FH, Sundgaard-Riise K, Reisin ED et al. Dimorphic cardiac adaptation to obesity and arterial hypertension. Ann Int Med 1983;99:757–761.PubMedGoogle Scholar
  9. 9.
    Kaltman AJ, Goldring RM. Role of circulatory congestion in the cardiorespiratory failure of obesity. Am J Med 1976;60:645–653.PubMedGoogle Scholar
  10. 10.
    Iskandrian AS. Radionuclide evaluation of cardiac function in obesity. Am Heart J 1986;111(5):1003.PubMedGoogle Scholar
  11. 11.
    Alpert MA, Singh A, Terry BE et al. Effect of exercise on left ventricular systolic function and reserve in morbid obesity. Am J Cardiol 1989;63(20):1478–1482.PubMedGoogle Scholar
  12. 12.
    Kinner B, Goos H, Ewers P et al. The relation of anthropometric parameters and echocardiography findings in the evaluation of left ventricular form and function in extreme obesity. Z Gesamte Inn Med 1989;44(5):152–157.PubMedGoogle Scholar
  13. 13.
    Nakajima T, Fujioka S, Tokunaga K et al. Noninvasive study of left ventricular performance in obese patients: influence of duration of obesity. Circulation 1985;71:481–486.PubMedGoogle Scholar
  14. 14.
    Alpert MA, Terry BE, Kelly DL. Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol 1985;55:783–786.PubMedGoogle Scholar
  15. 15.
    Romano M, Carella G, Cotecchia MR et al. Am Heart J 1986;112:356.PubMedGoogle Scholar
  16. 16.
    Nakajima T, Fujioka S, Tokunaga K et al. Correlation of intraabdominal fat accumulation and left ventricular performance in obesity. Am J Cardiol 1989;64(5):369–373.PubMedGoogle Scholar
  17. 17.
    Messerli FH, Sundgaard-Riise K, Dreslinski GR et al. Disparate cardiovascular effects of obesity and hypertension. Am J Med 1983;74:808–812.PubMedGoogle Scholar
  18. 18.
    Messerli FH, Christie B, DeCarvalho JGR et al. Obesity and essential hypertension: haemodynamics, intravascular volume, sodium excretion and plasma renin activity. Arch Intern Med 1981;141:81–85.PubMedGoogle Scholar
  19. 19.
    Amad KH, Brennan JC, Alexander JK. The cardiac pathology of chronic exogenous obesity. Circulation 1965;32:740–745.PubMedGoogle Scholar
  20. 20.
    Wilcken DE. Left ventricular volume in man; the relation to heart rate and to end-diastolic pressure. Australas Ann Med 1968;17(3): 195–205.PubMedGoogle Scholar
  21. 21.
    Alexander JK. The cardiomyopathy of obesity. Prog Cardiovasc Dis 1985;27:325–333.PubMedGoogle Scholar
  22. 22.
    Alexander JK. Obesity and the heart. Curr Prob Cardiol 1980;5:6–41.Google Scholar
  23. 23.
    Messerli FH. Cardiovascular effects of obesity and hypertension. Lancet 1982;1:1165–1168.PubMedGoogle Scholar
  24. 24.
    Carabello BA, Gittens L. Cardiac mechanics and function in obese normotensive persons with normal coronary arteries. Am J Cardiol 1987;59(5):469–473.PubMedGoogle Scholar
  25. 25.
    Messerli FH. Cardiopathy of obesity-a not-so-Victorian Disease. New Eng J Med 1986;314(6):378–380.PubMedGoogle Scholar
  26. 26.
    Messerli FH, Ventura HO, Elizardi DJ et al. Hypertension and sudden death: increased ventricular ectopic activity in left ventricular hypertrophy. Am J Med 1984;77;18–22.PubMedGoogle Scholar
  27. 27.
    Alexander JK, Pettigrove JR. Obesity and congestive heart failure. Geriatrics 1967,22:101–106.PubMedGoogle Scholar
  28. 28.
    Garavaglia GE, Messerli FH, Nunez BD et al. Myocardial contractility and left ventricular function in obese patients with essential hypertension. Am J Cardiol 1988;62(9):594–597.PubMedGoogle Scholar
  29. 29.
    Mirsky I. Elastic properties of the myocardium: a quantitative approach with physiological and clinical applications. In: Handbook of physiology. The cardiovascular system, Bethesda, MD: Am Physiol Soc, 1979, Sect 2, Vol 1, Ch 14:497–531.Google Scholar
  30. 30.
    Paradise NF, Pilati CF, Payne WR, et al. Left ventricular function of the isolated genetically obese rat’s heart. Am J Physiol 1985; 248: H438–H444.PubMedGoogle Scholar
  31. 31.
    Alpert MA, Singh A, Terry BE et al. Effect of exercise and cavity size on right ventricular function in morbid obesity. Am J Cardiol 1989;64:1361–1365.PubMedGoogle Scholar
  32. 32.
    Ramhamadany E, Dasgupta P, Brigden G et al. Cardiovascular changes in obese subjects on very low calorie diet. Int J Obes 1989;13(Suppl 2):95–99.PubMedGoogle Scholar
  33. 33.
    Dreslinski GR, Frolich ED, Dunn FG et al. Echocardiographic diastolic ventricular abnormality in hypertensive heart disease: atrial emptying index. Am J Cardiol 1981;47:1087–1090.PubMedGoogle Scholar
  34. 34.
    Lavie CJ, Amodeo C, Ventura HO et al. Left atrial abnormalities indicating diastolic ventricular dysfunction in cardiopathy of obesity. Chest 1987;92(6); 1042–1046.PubMedGoogle Scholar
  35. 35.
    Alexander JK, Peterson KL. Cardiovascular effects of weight reduction. Circulation 1972;45:310–318.PubMedGoogle Scholar
  36. 36.
    Alexander JK. The cardiomyopathy of obesity. Prog Cardiov Dis 1985;27:325–334.Google Scholar
  37. 37.
    Archibald EH, Stallings VA, Pencharz PB et al. Changes in intraventricular septal thickness left ventricle wall thickness and left ventricular volume in obese adolescents on a high protein weight reducing diet. Int J Obes 1989;13(3):265–269.PubMedGoogle Scholar
  38. 38.
    MacMahon SW, Wilcken DEL, MacDonald GJ. The effect of weight reduction on left ventricular mass: a randomized controlled trial in young, overweight mildly hypertensive patients. New Eng J Med 1986;314:334–339.PubMedGoogle Scholar
  39. 39.
    Tuck ML, Sowers J, Dornfeld L et al. The effect of weight reduction on blood pressure, plasma renin activity and plasma aldosterone levels in obese patients. N Engl J Med 1981;304:930–933.PubMedGoogle Scholar
  40. 40.
    Crandall DL, Lizzo FH, Cervoni P. Alterations in cardiac composition with weight reduction in the obese rat. Metabolism 1985;34(5):405–407.PubMedGoogle Scholar
  41. 41.
    Kinner B, Ries W, Sauer I et al. Changes in noninvasive cardiovascular parameters by inpatient weight reduction. Z Gesamte Inn Med 1985;40(12):369–372.PubMedGoogle Scholar
  42. 42.
    Caviezel F, Margonato A, Slaviero G. et al. Early improvement of left ventricular function during caloric restriction in obesity. Int J Obes 1986;10:421–426.PubMedGoogle Scholar
  43. 43.
    Garcia MJ, McNamara PM, Gordon T et al. Morbidity and mortality in diabetics in the Framingham population. Sixteen year follow-up study. Diabetes 1974;23:105–111.PubMedGoogle Scholar
  44. 44.
    Reckless JPD. The epidemiology of heart disease in diabetes mellitus. In: Taylor KG (ed.), Diabetes and the Heart. Castle House Publications Ltd, 1987:1–18.Google Scholar
  45. 45.
    Lundbaek K. Diabetic angiopathy. A specific vascular disease. Lancet 1954;i:377–379.Google Scholar
  46. 46.
    Zoneraich S. Angina pectons in diabetic patients with normal coronary arteries, [letter] J Am Med Assoc 1979;241:2311.Google Scholar
  47. 47.
    Selvester RH, Rubin HB, Hamlin JA et al. New quantitative vectorcardiographic criteria for the detection of unsuspected myocardial infarction in diabetics. Am Heart J 1968;75:335–348.PubMedGoogle Scholar
  48. 48.
    Fisher BM, Gillen G, Lindop GBM et al. Cardiac function and coronary arteriography in asymptomatic type 1 (insulin-dependent) diabetic patients: evidence for a specific diabetic heart disease. Diabetologia 1986;29:706–712.PubMedGoogle Scholar
  49. 49.
    Watson RDS, Waldron S. Heart disease and diabetes mellitus. In: Taylor KG (ed), Diabetes and the heart. Castle House Publications Ltd, 1987:19–41.Google Scholar
  50. 50.
    Vitolo E, Madoi S, Sponzilli C et al. Vectorcardiographic evaluation of diabetic cardiomyopathy and of its contributing factors. Acta Diabetol Lat 1988;25:227–234.PubMedGoogle Scholar
  51. 51.
    Riff ER, Riff KM. Abnormalities of myocardial depolarization in overt, subclinical and prediabetes. A vectorcardiographic study. Diabetes 1974;23:572–578.PubMedGoogle Scholar
  52. 52.
    Fischer VW, Barner HB, Leskiw ML. Capillary basal laminar thickness in diabetic human myocardium Diabetes 1979;28:713–719.Google Scholar
  53. 53.
    Fischer VW, Barner HB, LaRose LS. Quadriceps and myocardial capillary basal laminae. Their comparison in diabetic patients. Arch Pathol Lab Med 1982;106:336–341.PubMedGoogle Scholar
  54. 54.
    Fischer VW, Barner HB, LaRose LS. Pathomorphologic aspects of muscular tissue in diabetes mellitus. Hum Pathol 1984;15:1127–1236.PubMedGoogle Scholar
  55. 55.
    Rubier S, Dlugash J, Yuceoglu YZ et al. New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 1972;30:595–602.Google Scholar
  56. 56.
    Hamby RI, Zoneraich S, Sherman L. Diabetic cardiomyopathy. J Am Med Assoc 1974;229:1749–1754.Google Scholar
  57. 57.
    Zoneraich S, Silverman G, Zoneraich O. Primary myocardial disease, diabetes mellitus and small vessel disease. Am Heart J 1980;100:754–755.PubMedGoogle Scholar
  58. 58.
    Regan TJ, Lyons MM, Ahmed SS et al. Evidence for cardiomyopathy in familial diabetes mellitus. J Clin Invest 1977;60:884–899.PubMedGoogle Scholar
  59. 59.
    Crall FV Jr, Roberts WC. The extramural and intramural coronary arteries in juvenile diabetes mellitus: analysis of nine necropsy patients aged 19 to 38 years with onset of diabetes before age 15 years. Am J Med 1978;64:221–230.PubMedGoogle Scholar
  60. 60.
    van Hoeven KH, Factor SM. A comparison of the pathological spectrum of hypertensive, diabetic and hypertensive-diabetic heart disease. Circulation 1990;82(3):848–855.PubMedGoogle Scholar
  61. 61.
    Factor SM, Minase T, Sonnenblick EH. Clinical and morphological features of human hypertensive-diabetic cardiomyopathy. Am Heart J 1980;99:446–458.PubMedGoogle Scholar
  62. 62.
    Factor SM. Intramural pathology in the diabetic heart: interstitial and microvascular alterations. Mt Sinai J Med 1982;49:208–214.PubMedGoogle Scholar
  63. 63.
    Shirey EK, Proudfit WL, Hawk WA. Primary myocardial disease. Correlation with clinical findings, angiographic and biopsy diagnosis. Follow-up of 139 patients. Am Heart J 1980;99:198–207.PubMedGoogle Scholar
  64. 64.
    Ledet T. Diabetic cardiopathy: quantitative histological studies of the heart from young juvenile diabetics. Acta Pathol Microbiol 1976;84(sect A):421–428.Google Scholar
  65. 65.
    Nunoda S, Genda A, Sugihara N et al. Quantitative approach to the histopathology of the biopsied right ventricular myocardium in patients with diabetes mellitus. Heart Vessels 1985;l(l):43–47.Google Scholar
  66. 66.
    Yang Q, Kiyoshige K, Fujimoto T et al. Signal-averaging electrocardiogram in patients with diabetes mellitus. Jpn Heart J 1990;31(l):25–33.PubMedGoogle Scholar
  67. 67.
    Sutherland CG, Fisher BM, Frier BM et al. Endomyocardial biopsy pathology in insulindependent diabetic patients with abnormal ventricular function. Histopathology 1989;14(6):593–602.PubMedGoogle Scholar
  68. 68.
    Roy TM, Peterson HR, Snider HL et al. Autonomic influence on cardiovascular performance in diabetic subjects. Am J Med 1989;87(4):382–388.PubMedGoogle Scholar
  69. 69.
    Karlefors T. Circulatory studies during exercise with particular reference to diabetics. Acta Med Scand 1966;180(Suppl):449.Google Scholar
  70. 70.
    Zarick SW, Nesto RW. Diabetic cardiomyopathy. Am Heart J 1989;118(5 Pt l):1000–1012.Google Scholar
  71. 71.
    Ahmed SS, Jaferi GA, Narang RM et al. Preclinical abnormality of left ventricular function in diabetes mellitus. Am Heart J 1975;89:153–158.PubMedGoogle Scholar
  72. 72.
    Cellina G, Lo Cicero G, Brina A et al. Reversible alteration of myocardial function in gestational diabetes. Eur Heart J 1983;4:59–63.PubMedGoogle Scholar
  73. 73.
    Dai RH, Zhong XL, Zhu BQ et al. Diabetic cardiopathy. Chin Med J. 1982;95:71–75.PubMedGoogle Scholar
  74. 74.
    Jermendy G, Kammerer L, Koltai ZM et al. Preclinical abnormality of left ventricular performance in patients with insulin-dependent diabetes mellitus. Acta Diabetol Lat 1983;20:311–320.PubMedGoogle Scholar
  75. 75.
    Jermendy G, Koltai ZM, Kammerer L et al. Myocardial systolic alterations of insulin-dependent diabetes mellitus in rest. Acta Cardiol 1984;39:185–190.PubMedGoogle Scholar
  76. 76.
    Rynkiewicz A, Semetkowska-Jurkiewicz E, Wyrzykowski B. Systolic and diastolic time intervals in young diabetics. Br Heart J 1980;44:280–283.PubMedGoogle Scholar
  77. 77.
    Seneviratne BI. Cardiac cardiomyopathy: the preclinical phase. Br Med J 1977;i:1444–1446.Google Scholar
  78. 78.
    Shapiro LM, Leatherdale BA, Coyne ME et al. Prospective study of heart disease in untreated maturity onset diabetics. Br Heart J 1980;44:342–348.PubMedGoogle Scholar
  79. 79.
    Shapiro LM, Howat AP, Calter MM. Left ventricular function in diabetes mellitus. I: methodology and prevalence and spectrum of abnormalities. Br Heart J 1981;45:122–128.PubMedGoogle Scholar
  80. 80.
    Zoneraich S, Zoneraich O, Rhee JJ. Left ventricular performance in diabetic patients without clinical heart disease. Evaluation by systolic time intervals and echocardiography. Chest 1977;72:748–751.PubMedGoogle Scholar
  81. 81.
    Atalli JR, Sachs RN, Valensi P et al. Asymptomatic diabetic cardiomyopathy: a noninvasive study. Diabetes Res Clin Pract 1988;4:183–190.Google Scholar
  82. 82.
    Uusitupa M, Sitonen O, Pyorala K et al. Left ventricular function in newly diagnosed non-insulin-dependent type 2 diabetics evaluated by systolic time intervals and echocardiography. Acta Med Scand 1985;217:379–388.PubMedGoogle Scholar
  83. 83.
    Airaksinen K, Ikaheimo M, Kaila J et al. Systolic time intervals and the QT-QS2 interval in young female diabetics. Ann Clin Res 1984;16:188–191.PubMedGoogle Scholar
  84. 84.
    dei Cas L, Zuliani U, Manca C et al. Noninvasive evaluation of left ventricular performance in 294 diabetic patients without clinical heart disease. Acta Diabetol Lat 1980;17:145–152.Google Scholar
  85. 85.
    Pillsbury HC, Hung W, Kyle MC et al. Arterial pulse waves and velocity and systolic time intervals in diabetic children. Am Heart J 1974;87:783–790.PubMedGoogle Scholar
  86. 86.
    Posner J, Ilya R, Wanderman K et al. Systolic time intervals in diabetes. Diabetologia 1983;24:249–252.PubMedGoogle Scholar
  87. 87.
    Rubier S, Sajadi MR, Araoye MA et al. Noninvasive estimation of myocardial performance in patients with diabetes. Effect of alcohol administration. Diabetes, 1978;27:127–134.Google Scholar
  88. 88.
    Northcote RJ, Semple C, Kesson CM et al. Systolic time intervals in adolescents with insulin-dependent diabetes mellitus. Diabetic Med 1985;2:465–467.PubMedGoogle Scholar
  89. 89.
    Shapiro LM, Leatherdale BA, MacKinnon J et al. Left ventricular function in diabetes mellitus II. Relation between clinical features and left ventricular function. Br Heart J 1981;45:129–132.PubMedGoogle Scholar
  90. 90.
    Shapiro LM. Echocardiographic features of impaired ventricular function in diabetes mellitus. Br Heart J 1982;47:439–444.PubMedGoogle Scholar
  91. 91.
    Sanderson JE, Brown DJ, Rivellese A et al. Diabetic cardiomyopathy? An echocardiographic study of young diabetics. Br Med J 1978;i:404–407.Google Scholar
  92. 92.
    Uusitupa M, Sitonen O, Aro A et al. Effect of correction of hyperglycemia on left ventricular function in non-insulin-dependent (type 2) diabetics. Acta Med Scand 1983;213:363–368.PubMedGoogle Scholar
  93. 93.
    Avogaro A, Nosadini R, Doria A et al. Myocardial metabolism in insulin-deficient diabetic humans without coronary artery disease. Am J Physiol 1990;258(4 Pt l):E606–E618.PubMedGoogle Scholar
  94. 94.
    Cameron NE, Cotter MA, Robertson S. Contractile properties of cardiac papillary muscle in streptozotocin-diabetic rats and the effects of aldose reductase inhibition. Diabetologia 1989;32(6):365–370.PubMedGoogle Scholar
  95. 95.
    Sampson MJ, Chambers J, Springings D et al. Intraventricular septal hypertrophy in type 1 diabetic patients with microalbuminuria or early proteinuria. Diabetic Med 1990;7(2):126–131.PubMedGoogle Scholar
  96. 96.
    Paillole C, Dahan M, Paycha F et al. Prevalence and significance of left ventricular filling abnormalities determined by Doppler echocardiography in young type I (insulin-dependent) diabetic patients. Am J Cardiol 1989;64(16):1010–1016.PubMedGoogle Scholar
  97. 97.
    Fein FS, Miller-Green B, Sonnenblick EH. Altered myocardial mechanics in diabetic rabbits. Am J Physiol 1985;248(5 Pt 2):H729–H736.PubMedGoogle Scholar
  98. 98.
    Schaffer SW, Mozaffari MS, Artman M et al. Basis for myocardial mechanical defects associated with non-insulin-dependent diabetes. Am J Physiol 1989;256:(1 Pt l):E25–E30.PubMedGoogle Scholar
  99. 99.
    Friedman HS, Sacerdote A, Bandu I et al. Abnormalities of the cardiovascular response to cold pressor test in type I diabetes. Correlation with blood glucose control. Arch Int Med 1984;144:43–47.Google Scholar
  100. 100.
    Fisher BM, Cleland JGF, Dargie HJ et al. Noninvasive evaluation of cardiac function in young patients with Type 1 diabetes. Diabetic Med 1989;6:677–681.PubMedGoogle Scholar
  101. 101.
    Gregor P, Widimsky P, Rostlapil J et al. Echocardiographic picture in diabetes mellitus. Jpn Heart J 1984;25:969–977.PubMedGoogle Scholar
  102. 102.
    Hausdorf G, Rieger U, Koepp P. Cardiomyopathy in childhood diabetes mellitus: incidence, time of onset and relation to metabolic control. Int J Cardiol 1988;19:225–236.PubMedGoogle Scholar
  103. 103.
    Lababidi ZA, Goldstein DE. High prevalence of echocardiographic abnormalities in diabetic youths. Diabetes Care 1983;6:18–22.PubMedGoogle Scholar
  104. 104.
    Pozzoli G, Vitolo E, Collini P et al. Assessment of left ventricular function with M-mode echocardiography in a selected group of diabetic patients. Acta Diabetol Lat 1984;21:71–84.PubMedGoogle Scholar
  105. 105.
    Rubier S, Sajadi MRM, Araoye MA et al. Noninvasive estimation of myocardial performance in patients with diabetes. Effect of alcohol administration. Diabetes 1978,27:127–134.Google Scholar
  106. 106.
    Airaksinen K, Ikaheimo M, Kaila J et al. Impaired left ventricular filling in young female diabetics. An echocardiographic study. Acta Med Scand 1984;216:509–516.PubMedGoogle Scholar
  107. 107.
    Airaksinen K, Ikaheimo M, Linnaluoto M et al. Increased left atrial size in young women with insulin-dependent diabetes: a pre-clinical sign of the specific heart disease of diabetes? Diabetes Res 1987;6:37–41.PubMedGoogle Scholar
  108. 108.
    Danielson R, Nordrehaug JE, Lien E et al. Subclinical left ventricular abnormalities in young subjects with long-term Type 1 diabetes mellitus detected by digitized M-mode echocardiography. Am J Cardiol 1987;60:143–146.Google Scholar
  109. 109.
    Thuesen L, Christiansen JS, Mogensen CE et al. Cardiac hyperfunction in insulin-dependent diabetic patients developing microvascular complications. Diabetes 1988;37:851–856.PubMedGoogle Scholar
  110. 110.
    Thuesen L, Christiansen JS, Falstie-Jensen N et al. Increased myocardial contractility in short-term type 1 diabetic patients: an echocardiographic study. Diabetologia 1985;28:822–826.PubMedGoogle Scholar
  111. 111.
    Uusitupa M, Mustonen J, Laakso M et al. Impairment of diastolic function in middle-aged type 1 diabetic patients free of cardiovascular disease. Diabetologia 1988;31:783–791.PubMedGoogle Scholar
  112. 112.
    Danielsen R, Nordrehaug JE, Vik-Mo H. Left ventricular diastolic function in young long-term type 1 (insulin-dependent) diabetic men during exercise assessed by digitized echocardiography. Eur Heart J 1988;9:395–402.PubMedGoogle Scholar
  113. 113.
    Airaksinen K, Koistenen MJ, Ikaheimo M et al. Augmentation of atrial contribution to left ventricular filling in IDDM subjects as assessed by Doppler echocardiography. Diabetes Care 1989;12:159–161.PubMedGoogle Scholar
  114. 114.
    Zarich SW, Arbuckle BE, Cohen LR et al. Diastolic abnormalities in young asymptomatic diabetic patients assessed by pulsed doppler echocardiography. J Am Coll Cardiol 1988;12:114–120.PubMedGoogle Scholar
  115. 115.
    Arvan S, Singal K, Knapp R et al. Subclinical left ventricular abnormalities in young diabetics. Chest 1988;93:1031–1034.PubMedGoogle Scholar
  116. 116.
    Harrower AD, McFarlane G, Parekh P et al. Cardiac function during stress testing in longstanding insulin-dependent diabetics. Acta Diabetol Lat 1983;20:179–183.PubMedGoogle Scholar
  117. 117.
    Goldweit RS, Borer JS, Jovanovic LG et al. Relation of haemoglobin Al and blood glucose to cardiac function in diabetes mellitus. Am J Cardiol 1985;56(10):642–646.PubMedGoogle Scholar
  118. 118.
    Larsen S, Brynjolf I, Birch K et al. The effect of continuous subcutaneous insulin on cardiac performance during exercise in insulin-dependent diabetics. Scand J Clin Invest 1984;44:683–691.PubMedGoogle Scholar
  119. 119.
    Mildenberger RR, BarScholomo B, Druck MN et al. Clinically unrecognized ventricular dysfunction in young diabetic patients. J Am Coll Cardiol 1984;4:234–238.PubMedGoogle Scholar
  120. 120.
    Vered Z, Battler A, Segal P et al. Exercise-induced left ventricular dysfunction in young men with asymptomatic diabetes mellitus (diabetic cardiomyopathy). Am J Cardiol 1984;54:633–637.PubMedGoogle Scholar
  121. 121.
    Fisher BM, Gillen G, Ong-Tone L et al. Cardiac function and insulin-dependent diabetes: radionuclide ventriculography in young diabetics. Diabetic Med 1985;2:251–256.PubMedGoogle Scholar
  122. 122.
    Zola B, Kahn JK, Juni JE et al. Abnormal cardiac function in diabetic patients with autonomic neuropathy in the absence of ischaemic heart disease. J Clin Endocrin Metab 1986;63:208–214.Google Scholar
  123. 123.
    Kahn JK, Zola B, Juni JE et al. Radionuclide assessment of left ventricular diastolic filling in diabetes mellitus with and without cardiac autonomic neuropathy. J Am Coll Cardiol 1986;7:1303–1309.PubMedGoogle Scholar
  124. 124.
    Margonato A, Gerundini P, Vicedomini G et al. Abnormal cardiovascular response to exercise in young asymptomatic diabetic patients with retinopathy. Am Heart J 1986;112:554–560.PubMedGoogle Scholar
  125. 125.
    Pauwels EK, Lemkes HH, Gonsalves S et al. Scintigraphic evidence of asymptomatic impaired left ventricular function in type 1 diabetics. Clin Nucl Med 1985;10(12):861–864.PubMedGoogle Scholar
  126. 126.
    Ferraro S, Fazio S, Santomauro M et al. Cardiac function and sympathetic activity in young diabetics. Diab Res Clin Pract 1990;8(2):91–99.Google Scholar
  127. 127.
    Sykes CA, Wright AD, Malins JM et al. Changes in systolic time intervals during treatment of diabetes mellitus. Br Heart J 1977;39:255–259.PubMedGoogle Scholar
  128. 128.
    Mustonen J, Laakso M, Uusitupa M et al. Improvement of left ventricular function after starting insulin treatment in patients with non-insulin-dependent diabetes. Diabetes Res 1988;9:27–30.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1992

Authors and Affiliations

  • Ralph Abraham

There are no affiliations available

Personalised recommendations