Radionuclide Assessment of Left Ventricular Function in Middle-Aged Asymptomatic Non-Insulin-Dependent Diabetic Patients

  • I. Yasuda
  • K. Kawakami
  • T. Shimada
  • K. Tanigawa
  • R. Murakami
  • S. Izumi
  • S. Morioka
  • Y. Kato
  • K. Moriyama
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 130)


The incidence of congestive heart failure is increased in patients with diabetes mellitus (1,2,3) and there is evidence that cardiac dysfunction occurs in diabetic patients with normal coronary arteries (4,5), but the causes of these abnormalities are still unclarified. Some authors (6,7) have suggested the existence of a specific diabetic cardiomyopathy. Rubler et al. (6) reported four adult-onset diabetic patients who had cardiomegaly and congestive heart failure in the absence of major coronary artery disease or hypertension. Hamby et al. (7) observed a high incidence of diabetes mellitus in their series of patients with idiopathic cardiomyopathy. On the other hand, it has been proposed that metabolic derangements of diabetes may impair the left ventricular function (4,8). Several investigators have shown that abnormalities of left ventricular systolic (9–14) or diastolic (4,8,15–17) function or both (18,19) are common in diabetics even without coronary artery disease and clinical manifestations of congestive heart failure. Abnormalities of the left ventricular function have been shown in diabetic patients at rest (4,9,20,21) and also during exercise (10-14). Whether these abnormalities result either from microangiopathy in the heart or from metabolic derangements inherent to diabetes mellitus remains unclear.


Left Ventricular Ejection Fraction Diabetic Group Peak Filling Rate Radionuclide Ventriculography Total Workload 
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  1. 1.
    McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure. The Framingham study. New Engl J Med 1971;285:1441–1445,.PubMedCrossRefGoogle Scholar
  2. 2.
    Kannel WB, Hjortland M, Castelli WP. The role of diabetes in congestive heart failure. The Framingham study. Am J Cardiol 1974;34:29–34.PubMedCrossRefGoogle Scholar
  3. 3.
    Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA 1979;241:2035.PubMedCrossRefGoogle Scholar
  4. 4.
    Regan TJ, Ettinger PO, Khan MI, Jesrani MU, Lyons MM, Oldewurfel HA, Weber M. Altered myocardial function and metabolism in chronic diabetes mellitus without ischemia in dogs. Circ Res 1974;35:222–227.CrossRefGoogle Scholar
  5. 5.
    Ahmed SS, Jaferi GA, Narang RM, Regan TJ. Preclinical abnormality of left ventricular function in diabetes mellitus. Am Heart J 1975;89:153–158.PubMedCrossRefGoogle Scholar
  6. 6.
    Rubier SR, Dluglash J, Yuceoglu YZ, Kumral T, Branwood AW, Grishman A. New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 1972;30:595–602.CrossRefGoogle Scholar
  7. 7.
    Hamby RI, Zoneraich S, Sherman L. Diabetic cardiomyopathy. JAMA 1974;229:1749–1754.PubMedCrossRefGoogle Scholar
  8. 8.
    Regan TJ, Lyons MM, Ahmad SS, Levinson GE, Oldewurtel HA, Ahmed MR, Haider B. Evidence for cardiomyopathy in familial diabetes mellitus. J Clin Invest 1977;60:884–899.PubMedCrossRefGoogle Scholar
  9. 9.
    Zoneraich S, Zoneraich O, and Rhee JJ. Left ventricular performance in diabetic patients without clinical heart disease. Evaluation by systolic time intervals and echocardiography. Chest 1977;72:748–751.PubMedCrossRefGoogle Scholar
  10. 10.
    Vered Z, Batler A, Segal P, Liberman D, Yerushalmi Y, Berezsin M, Neufeld HN. Exercise induced left venetricular dysfunction in young men with asymptomatic diabetes mellitus (Diabetic cardiomyopathy). Am J Cardiol 1984;54:633–637.PubMedCrossRefGoogle Scholar
  11. 11.
    Mildenberger RR, Bar-Shlomo B, Druch M, Jablonsky G, Morch JE, Hilton D, Keushole AB, Forbath N, McLaughlin PR. Clinically unrecognized ventricular dysfunction in young diabetic patients. J Am Coll Cardiol 1984;4:234–238.PubMedCrossRefGoogle Scholar
  12. 12.
    Margonato A, Gerundini P, Vicedomini G, Gilardi MC, Pozza G, Fazio F. Abnormal cardiovascular response to exercise in young asymptomatic diabetic patients with retinopathy. Am Heart J 1986; Am Heart J 1986;112:554–560.Google Scholar
  13. 13.
    Fisher BM, Gillen G, Lindop GBM, Dargie HJ, Frier BM. Cardiac function and coronary arteriography in asymptomatic type I (insulin-dependent) diabetic patients: evidence for a specific diabetic heart disease. Diabetologia 1986;29:706–712.PubMedCrossRefGoogle Scholar
  14. 14.
    Mustonen JN, Uusitupa MIJ. Tahvaninen K, Tarwar S, Laakso M, Lansimies E, KuiKKa JT, Pyorala K. Impaired left ventricular systolic function during exercise in middle-aged insulin-dependent and noninsulindependent diabetic subjects without clinically evident cardiovascular disease. Am J Cardiol 1988;62:1273–1279.PubMedCrossRefGoogle Scholar
  15. 15.
    Kahn JK, Zola B, Juni JE, Vinik AI. Radionnuclide assessment of left ventricular diastolic filling in diabetes mellitus with and without cardiac autonomic neuropthy. J Am Coll Cardiol 1986;7:1303–1309.PubMedCrossRefGoogle Scholar
  16. 16.
    Uusitupa M, Mustonen J, Laako M, Vainio P, Lansimies E, Talwar S, Pyorala K. Impairment of diastolic function in middle-aged type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic patients free of cardiovascular disease. Diabetologia 1988;31:783–791.PubMedCrossRefGoogle Scholar
  17. 17.
    Ruddy TD, Shumak SL, Liu PP, Barnie A, Seawright SJ, McLaughlin PR, Zinman B. The relationship of cardiac diastolic dysfunction to conccurrent hormonal and metabolic status in type 1 diabetes mellitus. J Clin Endocrinol metab 1988;66:113–118.PubMedCrossRefGoogle Scholar
  18. 18.
    Shapiro LM, Leatherdale BA, MacKinnon J, Fletcher RF. Left ventricular function in diabetics. Relation between clinical features and left ventricular function. Br. Heart J. 1981;45:129–132.PubMedCrossRefGoogle Scholar
  19. 19.
    Shapiro LM, Echocardiographic features of impaired ventricular function in diabetes mellitus. Br Heart J 1982;47:439–444.PubMedCrossRefGoogle Scholar
  20. 20.
    Seneviratne BIB. Diabetic cardiomyopathy: the preclinical phase. Br Med J 1977;1:1444–1446.PubMedCrossRefGoogle Scholar
  21. 21.
    Sanderson JE, Brown DDJ, Rivellese A, Kohner E. Diabetic cardiomyopathy? An echocardiographic study of young diabetics. Br Med J 1978;l:404–407.CrossRefGoogle Scholar
  22. 22.
    Gorcia MJ, McNamara PM, Gordon T, Kannel WB. Morbiditiy and mortality in diabetics in the Framingham population. Diabetes 1974;23:105–111.Google Scholar
  23. 23.
    Abenavoli T, Rubier S, Fisher VJ, Axelrod HI, Zuckerman KP. Exercise testing with myocardial scintigraphy in asymptomatic diabetic patients. Circulation 1981;63:54–64.PubMedCrossRefGoogle Scholar
  24. 24.
    Caldwell, JH, Hamilton, GW, Jorensen SG, Richtie JL, Williams PL, Kennedy YW. The detection of coronary artery disease with radionuclide techniques: A comparison of rest-exercise thallium imaging and ejection fraction response. Circulation 1980;61:610.PubMedCrossRefGoogle Scholar
  25. 25.
    Okada RD, Boucher CA, Strauss HW, Pohost GM. Exercise radionuclide approaches to coronary artery disease. Am J Cardiol 1980;46:1188–1204.PubMedCrossRefGoogle Scholar
  26. 26.
    Ditzel J. Oxygen transport impairment in diabetes. Diabetes 1976;25(Suppl. 2):832.PubMedGoogle Scholar
  27. 27.
    Ledet T. Diabetic cardiopathy: quantitative histologic studies of the heart from young juvenile diabetes. Acta Pathol Microbiol Scand (A) 1976;84:421–428.Google Scholar
  28. 28.
    Genda A, Mizuno S, Nunoda S, Nakayama A, Igarashi Y, Sugihara N, Namura M, Takeda R, Bunko H, Hisada K. Clinical studies on diabetic myocardial disease using exercise testing with myocardial scintigraphy and endomyocardial biopsy. Clin Cardiol 1986;9:375–382.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1992

Authors and Affiliations

  • I. Yasuda
    • 1
  • K. Kawakami
    • 1
  • T. Shimada
    • 1
  • K. Tanigawa
    • 1
  • R. Murakami
    • 1
  • S. Izumi
    • 1
  • S. Morioka
    • 1
  • Y. Kato
    • 1
  • K. Moriyama
    • 1
  1. 1.Departments of Internal MedicineShimane Medical UniversityIzumoJapan

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