scholarly journals Association of glycemic variability with left ventricular diastolic function in type 2 diabetes mellitus

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Shun Yokota ◽  
Hidekazu Tanaka ◽  
Yasuhide Mochizuki ◽  
Fumitaka Soga ◽  
Kentaro Yamashita ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Glycemic Variability ◽  
Left Ventricular ◽  
Lv Diastolic Dysfunction ◽  
Lv Diastolic Function

Abstract Background Type 2 diabetes mellitus (T2DM) is a major cause of heart failure (HF) with preserved ejection fraction (HFpEF), usually presenting as left ventricular (LV) diastolic dysfunction. Thus, LV diastolic function should be considered a crucial marker of a preclinical form of DM-related cardiac dysfunction. However, the impact of glycemic variability (GV) on LV diastolic function in such patients remains unclear. Methods We studied 100 asymptomatic T2DM patients with preserved LV ejection fraction (LVEF) without coronary artery disease (age: 60 ± 14 years, female: 45%). GV was evaluated as standard deviation of blood glucose level using continuous glucose monitoring system for at least 72 consecutive hours. LV diastolic function was defined as mitral inflow E and mitral e’ annular velocities (E/e’), and > 14 was determined as abnormal. Results E/e’ in patients with high GV (≥ 35.9 mg/dL) was significantly higher than that in patients with low GV (11.3 ± 3.9 vs. 9.8 ± 2.8, p = 0.03) despite similar age, gender-distribution, and hemoglobin A1c (HbA1c). Multivariate logistic regression analysis showed that GV ≥ 35.9 mg/dL (odds ratio: 3.67; 95% confidence interval: 1.02–13.22; p < 0.05) was an independently associated factor, as was age, of E/e’ > 14. In sequential logistic models for the associations of LV diastolic dysfunction, one model based on clinical variables including age, gender and hypertension was not improved by addition of HbA1c (p = 0.67) but was improved by addition of high GV (p = 0.04). Conclusion Since HFpEF is a syndrome caused by diverse agents, reducing GV may represent a potential new therapeutic strategy for the prevention of the development of HFpEF in T2DM patients.

scholarly journals The chronic heart failure early stage predictors in type 2 diabetes mellitus

2021 ◽  
pp. 4-16
Author(s):  
D.V. Grazhdankina ◽  
◽  
A.A. Demin ◽  
I.A. Bondar ◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Duration Of Diabetes ◽  
Initial Symptoms

Introduction. Type 2 diabetes mellitus (T2DM) is considered to be the equivalent of cardiovascular disease due to its micro- and macrovascular complications. Insulin resistance and hyperinsulinemia, impaired glucose tolerance and fasting glucose, and their subsequent maladaptive responses lead to myocardial dysfunction several years before the onset of T2DM. Pathological changes in the cardiovascular system in T2DM can progress without any symptoms for a long time. Aim. To identify clinical, laboratory, echocardiographic predictors of the early manifestations of chronic heart failure (CHF) in patients with T2DM. Materials and methods. The study included 94 patients with T2DM with and without initial symptoms of CHF at the age of 40 to 65 years. All patients had obesity or excess body weight and arterial hypertension (AH), 37 patients had stable coronary heart disease (CHD). Patients underwent general clinical and laboratory examination, a 6-minute walk test (6MWT), echocardiography. The concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP ) was also determined. The patients were divided into 2 groups: without CHF symptoms (group 1, n = 54) and with initial symptoms of CHF (group 2, n = 40) and then these groups were compared. Results. Differences were revealed between the second and first groups in the duration of T2DM (10.5 vs 7.5 years, p = 0.02) and AH (15 vs 10 years, p = 0.009); the incidence of stable CHD (70 vs 16.7%, p < 0.0001); distance covered during 6MWT (375 vs 425 m, p < 0.0001); the median level of NT-proBNP (38.5 vs 27.2 pg/ml, p = 0.031); the left atrium (LA) size (4.4 vs 4.2 cm, p = 0.044); the left ventricular posterior wall thickness (PWT) (1.05 vs 0.95 cm, p = 0.02); the level of triglycerides (2.3 vs 1.6 mmol/l, p = 0.03) and the glomerular filtration rate (GFR) (74.1 vs 79.1 ml/min/1.73 m2, r = 0.04). The discriminant analysis revealed combination of factors associated with initial symptoms of CHF: the duration of CHD (taken as 0, if absent, p < 0.00001), PWT of the LV (p = 0.000007), GFR (p = 0.0009), the LA size (p = 0.005), the level of triglycerides (p = 0.03), the duration of T2DM (p = 0.046). The NT-proBNP level > 125 pg/ml was detected in 16% of patients with T2DM and correlated with the duration of diabetes over 10 years (p = 0.0085), the presence of stable CHD (p < 0.0001), and left ventricular mass index (p = 0.0005) and the ejection fraction of the LV (p < 0.0001). Conclusion. Predictors of the initial manifestations of chronic heart failure in patients with type 2 diabetes mellitus were the presence and duration of stable CHD, an increase in the PWT of the LV, the LA size, the level of triglycerides, and the duration of diabetes. An elevated level of NT-proBNP (more than 125 pg/ml) in patients with T2DM was detected in 16% of cases and was associated with the duration of diabetes for more than 10 years, presence of stable CHD, initial symptoms of CHF, left ventricular myocardial hypertrophy, and a lower left ventricular ejection fraction according to echocardiography.

Short-term flexibility of myocardial triglycerides and diastolic function in patients with type 2 diabetes mellitus

2008 ◽  
Vol 295 (3) ◽  
pp. E714-E718 ◽  
Author(s):  
Sebastiaan Hammer ◽  
Rutger W. van der Meer ◽  
Hildo J. Lamb ◽  
Hans H. de Boer ◽  
Jeroen J. Bax ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diastolic Function ◽  
Myocardial Function ◽  
Left Ventricular ◽  
Plasma Nefa ◽  
Short Term ◽  
Nonesterified Fatty Acids

Short-term caloric restriction increases plasma levels of nonesterified fatty acids (NEFAs) and is associated with increased myocardial triglyceride (TG) content and decreased myocardial function in healthy subjects. Whether this flexibility of myocardial TG stores and myocardial function is also present in patients with type 2 diabetes mellitus (T2DM) is yet unknown. Myocardial TG content and left ventricular (LV) ratio between the early (E) and atrial (A) diastolic filling phase (E/A) were determined using magnetic resonance (MR) spectroscopy and MR imaging, respectively, before and after a 3-day very low-calorie diet (VLCD) in 11 patients with T2DM. In addition, we studied patients after a 3-day VLCD combined with the antilipolytic drug acipimox. The VLCD induced myocardial TG accumulation [from 0.66 ± 0.09% (mean ± SE, baseline) to 0.98 ± 0.16%, P = 0.028] and a decrease in E/A ratio [from 1.00 ± 0.05 (baseline) to 0.90 ± 0.06, P = 0.002]. This was associated with increased plasma NEFA levels (from 0.57 ± 0.08 mmol/l at baseline to 0.92 ± 0.12, P = 0.019). After the VLCD with acipimox, myocardial TG content, diastolic function, and plasma NEFA levels were similar to baseline values. In conclusion, in patients with T2DM, a VLCD increases myocardial TG content and is associated with a decrease in LV diastolic function. These effects were not observed when a VLCD was combined with acipimox, illustrating the physiological flexibility of myocardial TG stores and myocardial function in patients with T2DM.

scholarly journals Left Ventricular Diastolic Function in Type 2 Diabetes Mellitus

2010 ◽  
Vol 3 (1) ◽  
pp. 24-31 ◽  
Author(s):  
Mikael Kjaer Poulsen ◽  
Jan Erik Henriksen ◽  
Jordi Dahl ◽  
Allan Johansen ◽  
Oke Gerke ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diastolic Function ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Ventricular Diastolic Function

scholarly journals Left ventricular dysfunction in patients with type 2 diabetes mellitus

2019 ◽  
Vol 7 (1) ◽  
pp. 27
Author(s):  
Manish Chandey ◽  
Robin Kamboj ◽  
Tejinder Sikri ◽  
Nivenjit Kaur
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diastolic Dysfunction ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Lv Diastolic Dysfunction

Background: Diabetes mellitus (DM) is on the increase globally. Cardiovascular complications, such as left ventricular dysfunction is a major cause of death in patients with type II DM. Prior to the development of symptomatic heart failure, subclinical left ventricular dysfunction (systolic and diastolic) may exist for some time. Aim of this study is to find out abnormalities in left ventricular function in patients of type 2 diabetes mellitus with help of 2D Colour Doppler Echocardiography. To find its correlation with glycemic control on the basis of glycosylated haemoglobin (Hba1c).Methods: Total 100 Patients of type 2 Diabetes Mellitus of duration more than 10 years of both sexes were included in the cross-sectional study conducted from Jan 2018 to Aug 2019.All the patients were assessed through clinical examination and 2-D echocardiography and control of diabetes determined on the basis of HbA1c.Results: Study consisted of 100 patients with type 2 DM, 55(55%) were females and 45(45%) males. Majority of patients were in the age group of 4th to 6th decade of life.  Diastolic dysfunction was present in 81(81%) patients. systolic dysfunction was present in 14(14%) patients. There was a linear increase in prevalence of diastolic dysfunction with increasing age, increased FPG, increased BMI. There was also significant correlation between LV diastolic dysfunction (LVDD) and LA size. While no statistical correlation found between gender, duration of diabetes, HbA1c with diastolic and systolic dysfunction.Conclusions: LV diastolic dysfunction is an early manifestation of diabetic cardiomyopathy. LVDD contributes significantly to morbidity of congestive heart failure in diabetic patients. Echocardiography is a very useful non-invasive tool in detecting LVDD and systolic dysfunction in type 2 DM patients. 

Abstract 710: Pioglitazone Treatment Reduces Epicardial Fat in Patients with Type 2 Diabetes Mellitus and Improves Left Ventricular Diastolic Function

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hiroyuki Nagai ◽  
Hiroshi Ito ◽  
Katsuomi Iwakura ◽  
Atsunori Okamura ◽  
Yasushi Koyama ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diastolic Function ◽  
Visceral Obesity ◽  
Left Ventricular ◽  
Epicardial Fat ◽  
Mitral Annulus Velocity ◽  
Pioglitazone Treatment

Visceral obesity is recognized as a risk factor for cardiovascular events and for diastolic dysfunction. Epicardial fat pad (EFP) is visceral adipose tissue, contains pro-inflammatory substances, and directly attached to epicardial coronary artery. It sometimes infiltrates into cardiac muscle, that may impair diastolic performance. Pioglitazone can reduce the abdominal visceral fat, that is associated with improvement of insulin sensitivity. In this study, we investigated whether pioglitazone can reduce EFP and can improve diastolic function in patients with type 2 diabetes mellitus (DM). Study population consisted of 97 DM patients. All patients underwent echocardiographic examination before and a mean of 9.1 months after pioglitazone. We measured end-systolic thickness of echo free space in front of the free wall of right ventricle to measure EFP. To assess LV diastolic performance, we measured early peak mitral annulus velocity (e′, cm/s) with tissue Doppler. HbA1c decreased (8.1 vs. 7.0%, p=0.0009), trigliceride decreased (179 vs. 135 mg/dl, p=0.0009), and HDL-cholesterol increased (49 vs. 52 mg/dl, p=0.003). Although there was no difference in body weight, EFP thickness significantly decreased (6.3 vs. 5.0mm, p<0.0001) after pioglitazone. Patients were divided into two groups based on EFP thickness at baseline (median value = 6 mm). The percent reduction in EFP is greater in thicker EFP group (≥ 6.0 mm)than in thinner EFP group (<6.0mm) (24 vs. 12 %). Although e′ velocity was comparable before and after pioglitazone in the thinner EFP group, it significantly increased in the thicker EFP group (5.7 vs. 6.7 cm/s, p=0.003). Pioglitazone treatment reduces EFP associated with an improvement in glucose control and in lipid profile among patients with DM. In patients with thicker EFP, the reduction of EFP was greater, that is associated with the better improvement in LV diastolic performance.

scholarly journals Influence of beta-blockers on mechanical dyssynchrony and cardiac remodeling in patients with ischemic chronic heart failure in the setting of revascularization

2019 ◽  
Vol 5 (1) ◽  
pp. 1-13
Author(s):  
Irina V. Askari ◽  
Olga A. Osipova
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Average Dose

Introduction: Diastolic dysfunction (DD) and cardiac dyssynchrony (DS) are involved in the progression of chronic heart failure (CHF). A comparative analysis was conducted of the effect of a 6-month course of nebivolol and bisoprolol on DD, DS and metalloproteinase-9 (MMP-9) level in patients with ischemic chronic heart failure with preserved ejection fraction (HFpEF) and with midrange ejection fraction (HFmrEF), as well as in patients with comorbid type 2 diabetes mellitus (T2DM) in the setting of coronary artery bypass grafting (CABG) after 6 months of therapy. Materials and methods: The study included 308 patients with CHFFC I-II, left ventricular ejection fraction (LVEF) &gt;40%, who had undergone CABG. The average dose of nebivolol in patients with DS 6 months later was 5.1±2.6 mg/day, and bisoprolol – 4.9±2.4 mg/day. Echocardiography (EchoCG) and evaluation of MMP-9 in blood plasma were performed. Mechanical myocardial asynchrony was determined by calculating the standard deviation of time to peak systolic myocardial velocity (TS-SD) and maximum segment delay (TS12) using a 6-basal and-midsegment model. Results and discussion: MMP-9 level in patients with CHF before CABG was 4.7 times higher (p&lt;0.001). MMP-9 correlated with LVEF (r=-0.60, p&lt;0.001), E/A (r=-0.49, p&lt;0.001), DT (r=0.43, p&lt;0.001), E` (r=-0.58, p&lt;0.001) and DS: TS12 (r=0.54, p&lt;0.001), TS-SD (r=0.49, p&lt;0.001). The six-month course of nebivolol improved the values of DS: TS12 – by 30% (p&lt;0.001), TS-SD – by 32% (p&lt;0.01) and reduced the MMP-9 level by 11% (p&lt;0.001). In patients with HFmrEF without DSnebivolol increased E/A by 19% (p&lt;0.01), E` – by 16% (P&lt;0.05), and decreased E/E’ by 9% (p&lt;0.05), DT – by 12% (p&lt;0.05). In patients with HFpEF and DM2, nebivolol reduced TS12 by 37% (p&lt;0.01), TS-SD – by 29% (p&lt;0.05) and MMP-9 – by 13% (p&lt;0.05). Conclusion: The positive effect of nebivolol on the DS, DD of the LV in patients with HFpEF, HFmrEF and with comorbid type 2 diabetes mellitus. The six-month course of nebivolol decreased the MMP-9 level in patients with ischemic CHF after CABG, including patients with T2DM.

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