Exercise Training Normalizes Timing of Left Ventricular Untwist Rate, but Not Peak Untwist Rate, in Individuals with Type 2 Diabetes and Diastolic Dysfunction: A Pilot Study

Background: Diastolic dysfunction in patients suffering from diabetes mellitus represents an earlier stage in the natural history of cardiomyopathy. This study was done to assess the left ventricular diastolic dysfunction in recently diagnosed (<5yr) Type 2 Diabetes Mellitus by Echocardiography and also to determine association of glycemic status (by HBA1c levels) with left ventricular diastolic dysfunction (LVDD).Methods: An observational descriptive study involving 100 diabetic patients, taken on first come first serve basis after applying inclusion and exclusion criteria. In all the subjects, other than routine investigations, HbA1c was estimated and echocardiography was done to evaluate LVDD.Results: Mean value of HbA1c in the study was 8.31+ 1.408 %. 63 out of 100 subjects had LVDD. There was significant positive correlation between HbA1c and LVDD (p value <0.001). As HbA1c increased, severity of LVDD increased. In this study, as BMI increased, HbA1c and LVDD increased & both findings were statistically significant (p value =0.001).Conclusion: Our study indicates that myocardial damage in patients with diabetes affects diastolic function before systolic function &higher HbA1C level is strongly associated with presence of LVDD. Patients should be advised strict control of diabetes in order to reduce the risk for developing LVDD which is a precursor for more advanced disease.Keywords: Diabetes mellitus, Diastolic dysfunction, BMI, HbA1c

Download Full-text

Sex-specific pattern of left ventricular hypertrophy and diastolic function in patients with type 2 diabetes mellitus

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa079 ◽

2020 ◽

Author(s):

Mei-Zhen Wu ◽

Yan Chen ◽

Yu-Juan Yu ◽

Zhe Zhen ◽

Ying-Xian Liu ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Type 2 Diabetes ◽

Diastolic Dysfunction ◽

Diastolic Function ◽

Cardiovascular Death ◽

Left Ventricular ◽

Specific Pattern

Abstract Aims Few prospective studies have evaluated sex-specific pattern, natural progression of left ventricular (LV) remodelling, and diastolic dysfunction in patients with type 2 diabetes (T2DM). The aim of this study was to study the sex-specific prevalence, longitudinal changes of LV remodelling, and diastolic dysfunction in patients with T2DM. Further, the prognostic value of diastolic function in women and men was also evaluated. Methods and results A total of 350 patients with T2DM (mean age 61 ± 11 years; women, 48.3%) was recruited. Detailed echocardiography was performed at baseline and after 25 months. A major adverse cardiovascular event (MACE) was defined as cardiovascular death, heart failure hospitalization, or myocardial infarction. Despite a similar age, prevalence of hypertension and body mass index, women had a higher prevalence of LV hypertrophy and diastolic dysfunction at baseline and follow-up compared with men. A total of 21 patients developed MACE (5 cardiovascular death, 9 hospitalization for heart failure, and 7 myocardial infarction) during a median follow-up of 56 months. Women with diastolic dysfunction had a higher incidence of MACE than those with normal diastolic function but this association was neutral in men. Multivariable Cox-regression analysis indicated that diastolic dysfunction was associated with MACE in women [hazard ratio = 6.30; 95% confidence interval (CI) = 1.06–37.54; P < 0.05] but not men (hazard ratio = 2.29, 95% CI = 0.67–7.89; P = 0.19). Conclusion LV hypertrophy and diastolic dysfunction, both at baseline and follow-up, were more common in women than men. Pre-clinical diastolic dysfunction was independently associated with MACE only in women with T2DM but was neutral in men.

Download Full-text

Association between adipocyte fatty acid-binding protein with left ventricular remodelling and diastolic function in type 2 diabetes: a prospective echocardiography study

Cardiovascular Diabetology ◽

10.1186/s12933-020-01167-5 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Mei-Zhen Wu ◽

Chi-Ho Lee ◽

Yan Chen ◽

Shuk-Yin Yu ◽

Yu-Juan Yu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Fatty Acid ◽

Diastolic Dysfunction ◽

Fatty Acid Binding Protein ◽

Cox Regression ◽

Left Ventricular ◽

Fatty Acid Binding ◽

Acid Binding Protein ◽

Lv Mass

Abstract Background The relationship between adipocyte fatty acid-binding protein (AFABP) and cardiac remodelling has been reported in cross-sectional studies, although with conflicting results. Type 2 diabetes mellitus (T2DM) is associated with left ventricular (LV) hypertrophy and diastolic dysfunction, as well as elevated circulating AFABP levels. Here we investigated prospectively the association between AFABP with the longitudinal changes of cardiac remodelling and diastolic dysfunction in T2DM. Methods Circulating AFABP levels were measured in 176 T2DM patients without cardiovascular diseases (CVD) at baseline. All participants received detailed transthoracic echocardiography both at baseline and after 1 year. Multivariable linear and Cox regression analyses were used to evaluate the associations of circulating AFABP levels with changes in echocardiography parameters and incident major adverse cardiovascular events (MACE), respectively. Results The median duration between baseline and follow-up echocardiography assessments was 28 months. Higher sex-specific AFABP quartiles at baseline were associated with increase in LV mass and worsening of average E/e′ (all P < 0.01). Multivariable linear regression demonstrated that AFABP in the highest quartile was independently associated with both increase in LV mass (β = 0.89, P < 0.01) and worsening of average E/e′ (β = 0.57, P < 0.05). Moreover, multivariable Cox regression analysis showed that elevated baseline circulating AFABP level independently predicted incident MACE (HR 2.65, 95% CI 1.16–6.05, P < 0.05) after adjustments for age, sex, body mass index, glycated haemoglobin, hypertension, dyslipidemia and presence of chronic kidney disease. Conclusion Circulating AFABP level at baseline predicted the development of LV hypertrophy, diastolic dysfunction and MACE in T2DM patients without CVD.

Download Full-text

433 Independent impact of metabolic syndrome on left ventricular longitudinal dysfunction in type 2 diabetes mellitus

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.246 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

O Casciano ◽

F Luciano ◽

S Cocozza ◽

R Sorrentino ◽

M Lembo ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Metabolic Syndrome ◽

Diastolic Dysfunction ◽

Filtration Rate ◽

Left Ventricular ◽

Diabetic Patients ◽

Lv Mass ◽

Lv Diastolic Dysfunction

Abstract Background The risk of cardiovascular (CV) disease in type 2 diabetes mellitus (T2DM) is highly heterogeneous and an adequate risk stratification is needed. CV risk mainly depends on concomitant risk factors, combined in the metabolic syndrome (MetS). Echocardiography is an useful tool for diagnosis of cardiac organ damage and CV risk stratification in T2DM. Purpose To investigate the effects of MetS on left ventricular (LV) structure and function in patients with T2DM with normal LV ejection fraction (LVEF) and without overt coronary artery disease (CAD) and heart failure symptoms/signs. Methods We prospectively recruited 384 consecutive, uncomplicated T2DM patients. All patients underwent clinical exam, blood sampling and complete echo-Doppler exam, including determination of 2D-echo derived global longitudinal strain (GLS). LV mass index ≥45 g/m^2.7 in women and ≥49 g/m^2.7 in men was used to characterize LV hypertrophy. LV longitudinal dysfunction was assumed for GLS < 20% in absolute values. LV diastolic dysfunction was identified according to 2016 ASE/EACVI recommendations. MetS was defined according to NCEP-ATP III criteria. Significant CAD including previous myocardial infarction, LV systolic dysfunction (= LVEF <50%), hemodinamically significant valvular heart disease, primary cardiomyopathies, permanent atrial fibrillation, glomerular filtration rate <30 ml/min and inadequate echo images were exclusion criteria. The study population was divided according to presence of MetS. Results 66% of the patients (254/384) met the criteria for MetS diagnosis. They had comparable age and heart rate with controls. Diabetic patients with MetS had higher glycated haemoglobin (HbA1c) (7.2 ± 1.3 vs. 6.9 ± 1.0%, p = 0.023) and uric acid (5.5 ± 1.4 vs. 4.9 ± 1.3 mg/dl, p = 0.001) than those without, and lower glomerular filtration rate (69.5 ± 15.0 vs 74.0 ± 12,1 ml/min, p = 0.004). MetS patients showed a higher LV mass index (p < 0.0001) and a greater prevalence of both LV hypertrophy (31.9 vs 12.5%, p < 0.0001) and diastolic dysfunction (52.6 vs. 32.8%, p = 0.007) (Figure). T2DM patients with MetS also had lower GLS (20.6 ± 2.1 vs. 21.9 ± 2.2%, p = 0.001), with a greater prevalence of LV longitudinal dysfunction (38.2 vs. 24.7%, p = 0.049) (Figure). After adjusting for age, T2DM duration, sex, HbA1c, uric acid, LV mass index and LV diastolic dysfunction by a multiple regression analysis in the pooled population, GLS reduction was independently associated with MetS (β coefficient = -0.184, p < 0.02) and LV mass index (β= -0.94, p = 0.04). Conclusion In patients with T2DM, the presence of MetS induces a greater prevalence not only of LV hypertrophy and diastolic dysfunction but also of LV longitudinal deformation impairment. GLS reduction in diabetic patients is associated with MetS independently of confounders including glycemic control and diabetic duration. Abstract 433 Figure. Rate of LV alterations according to MetS

Download Full-text

The clinical and experimental analysis of ventricular rhythm disturbances in the patients with type 2 diabetes mellitus suffering from diastolic cardiac insufficiency

Problems of Endocrinology ◽

10.14341/probl201561221-27 ◽

2015 ◽

Vol 61 (2) ◽

pp. 21-27

Author(s):

I P Tatarchenko ◽

N V Pozdnyakova ◽

A G Denisova ◽

O I Morozova

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diastolic Dysfunction ◽

Left Ventricular ◽

Cardiac Insufficiency ◽

Left Ventricular Ejection ◽

Ventricular Extrasystole ◽

Ventricular Ejection Fraction

The present study was focused on the assessment of electrophysiological, structural, and functional characteristics of the heart associated with ventricular rhythm disturbances in the patients with type 2 diabetes mellitus (DM2) suffering from diastolic cardiac insufficiency. The study involved a total of 128 patients with DM2 and coronary heart disease (CHD) exhibiting signs of functional class I-III chronic cardiac insufficiency and left ventricular ejection fraction over 50%. The patients were divided into three groups. Group 1 (n=55) included patients presenting with left ventricular relaxation. Group 2 (n=44) was comprised of the patients with the pseudo-normal type of diastolic dysfunction. Group 3 (n=29) consisted of the patients with restrictive diastolic dysfunction. The patients of the latter group were characterized by the high frequency of complicated forms of ventricular arrhythmia, such as Grade IV-V ventricular extrasystole (48.3%) and Grade III ventricular extrasystole (34.5%). Restrictive type of diastolic dysfunction was associated with the delayed fragmented activity in the end part of the ventricular complex in 72.4% of the patients. The close correlation between the left ventricular diastolic function and parameters of myocardial electrical remodeling was documented.

Download Full-text