scholarly journals Diabetic heart: Metabolic reasons for the development of cardiomyopathy

1996 ◽  
Vol 42 (6) ◽  
pp. 20-26
Author(s):  
E. I. Sokolov ◽  
O. S. Zaichikova
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Coronary Arteries ◽  
Diabetic Cardiomyopathy ◽  
Myocardial Dysfunction ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Volume Index ◽  
Dependent Diabetes Mellitus ◽  
Patients With Diabetes

Cardiovascular disease is a common cause of death in patients with diabetes mellitus (DM). The likelihood of developing heart failure with this disease increases, even if you take into account the influence of factors such as age, blood pressure, plasma cholesterol, body weight and the condition of the coronary arteries. The term "diabetic cardiomyopathy" was proposed in 1972 by S. Rubier et al. They performed postmortem autopsy of patients with diabetes complicated by diabetic nephropathy and congestive heart failure without arterial hypertension and severe atherosclerosis of the coronary arteries. The hemodynamic parameters of a group of patients with diabetes without hypertension without significant atherosclerotic changes in the coronary arteries according to angiography were studied by T. Regan et al. In these patients, a decrease in stroke volume index and an increase in diastolic pressure in the left ventricle were detected. The observed changes, indicating a decrease in left ventricular myocardial extensibility, were interpreted as signs of subclinical cardiomyopathy. Based on the results of an echocardiographic examination of patients with insulin-dependent diabetes mellitus (IDDM) Ch. Dimitar proposed the following stages of development of diabetic cardiomyopathy: I - increased myocardial contractility; II - systolic and diastolic functions are not impaired; III - the beginning of the development of diastolic dysfunction, a decrease in the "compliance" of the left ventricular myocardium and dilatation of the left atrium; IV - progression of diastolic myocardial dysfunction (DDM) and the addition of systolic dysfunction.

Abstract 4239: Speckle Tracking Imaging Detects Sub-Clinical Myocardial Dysfunction in Asymptomatic Patients with Type 2 Diabetes Mellitus

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Laura Ernande ◽  
Cyrille Bergerot ◽  
Ernst R Rietzschel ◽  
Marc L De Buyzere ◽  
Nico Van de Veire ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Cardiomyopathy ◽  
Speckle Tracking ◽  
Myocardial Dysfunction ◽  
Univariate Analysis ◽  
Radial Strain ◽  
Left Ventricular ◽  
Male Gender ◽  
Type Ii ◽  
Speckle Tracking Imaging

Diabetic cardiomyopathy, a major complication of diabetes mellitus (DM), is preceded by a silent phase of progressive left ventricular (LV) remodeling. Our aim was to evaluate whether speckle tracking imaging (STI) was able to detect early, sub-clinical myocardial dysfunction in a population of asymptomatic type II DM patients with no signs or history of heart disease and a normal conventional echo . 114 patients with type II DM (52 ± 4 years, 45 females, HbA1c 7.7 ± 1.4%) and 88 age-matched healthy volunteers (HV) without any cardiovascular risk factor (52 ± 3 years, 58 females) underwent a conventional and STI echocardiography (Vivid 7, GE). Mean longitudinal strain (S L ) was assessed from the basal, mid and apical segments of the myocardial walls in apical 2- and 4-chamber views. Mean radial strain (S R ) was calculated from the short-axis view at the midventricular level. Univariate and multivariate regression analyses were used to identify the parameters contributing to the difference in S L and S R between the 2 groups. Variables used for analysis were as follows: DM, gender, BMI, systolic (sBP) and diastolic blood pressure (dBP), heart rate, IVSd and PWd thickeness, LV end-diastolic (LVEDD) and end-systolic diameters (LVESD). Clinical, conventional echo and STI parameters in the 2 groups are summurized in the table . On univariate analysis, factors associated with a significant lower strain in type II DM patients were: DM, male gender, BMI, sBP and dBP for S L and DM, sex and LVESD for S R (p<0.05 for all). On multiple regression analysis, the only factors accociated with a significant decrease in strain in the DM group were DM (p = 0.005) and male gender (p = 0.008) for S L and DM (p = 0.01) for S R . STI is able to early detect subclinical myocardial dysfunction in a population with Type II DM. This decrease in S L and S R might be considered as a preclinical marker of diabetic cardiomyopathy.

scholarly journals P1754 Regional left ventricular longitudinal myocardial dysfunction in mitral valve prolapse could be primary

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Barbier ◽  
O A Annoh ◽  
G Liu ◽  
M Scorsin ◽  
S Moriggia ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Myocardial Dysfunction ◽  
Stroke Volume Index ◽  
Volume Overload ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Volume Index ◽  
Maximum Strain

Abstract Background Regional left ventricular dysfunction in patients with mitral valve prolapse (MVP) and normal ejection fraction has been described by different Authors, and recent data point to a dysfunction (prevalently longitudinal strain) of the myocardium of the LV base secondary to dilatation of the mitral annulus. Purpose To investigate degree and extent of regional LV dysfunction and its mechanisms in patients with MVP, severe regurgitation and normal global systolic function, compared to patients with equivalent degree of regurgitation but functional etiology (FMR). Methods Speckle-tracking echocardiography was performed in 30 controls (N), and in severe primary (MVP, n= 50) or functional (FMR, n= 20) mitral regurgitation, to measure global, regional and segmental longitudinal peak systolic strain (LPSS, %), and time delay of peak maximum strain (TTPd, ms, calculated as time to peak maximum strain - time of aortic valve closure). Maximum and minimum mitral annulus diameters and area were measured with 3D echo. We also evaluated as recommended: LV end-diastolic volume index (EDVi, ml/m2), ejection fraction (EF, %), and left atrial end-systolic volume index (LAESVi, ml/m2) with 2D echo; LV stroke volume index, and non-invasive pulmonary systolic (PSP, mmHg) and diastolic pressures (PDP), mmHg) with Doppler echo. Results Age, heart rate, BSA and systolic blood pressure were similar between groups. Atrial fibrillation was present in 34% of MVP and 71% of FMR patients. LV EF was normal in MVP and reduced in FMR (43 ± 14 % vs N, p&lt;.001). LV EDVi (MVP: 77 ± 20 ml/m2; FMR: 107 ± 35, both p&lt;.001 vs N) and LAESVi (MVP: 91 ± 26 ml/m2; FMR: 80 ± 30, both p&lt;.001 vs N) were similarly increased (volume overload) in MVP and FMR, as were PSP (MVP: 42 ± 23 ml/m2; FMR: 52 ± 25, both p&lt;.001 vs N) and PDP (MVP: 16 ± 6 ml/m2; MVP: 15 ± 5, both p&lt;.001 vs N). In FMR, LPSS was reduced globally (-12.8 ± 3.3, p&lt;.001 vs N and MVP) and similarly at LV base, papillary and apical levels. In contrast, in MVP global (-19.4 ± 3.7%) and apical (-23.4 ± 4.5%) LPSS were normal, whereas LV base (-12.3 ± 5.8%, p=.003 vs N) and papillary (-17.1 ± 4%, p=.024 vs N) LPSS were reduced; further, LPSS reduction was localized to the anterior (-16 ± 4, p=.028 vs N), lateral (-17 ± 5, p=.006 vs N) and posterior (-16 ± 6, p=.007 vs N) segments, and was associated with an increased TTPd in the same segments in MVP but not in FMR patients. At multivariate analysis, degree and localisation of regional myocardial dysfunction in patients with MVP was not related to the prolapsing scallop, dimension of the mitral annulus, degree of volume overload or pulmonary pressures, or stroke volume index. Conclusions In patients with MVP, severe regurgitation and normal EF, there is a specific dysfunction pattern of regional LV longitudinal function which appears to be primary and not dependent on the degree of preload increase, mitral annulus dilatation, or localization of the prolapsing scallop.

scholarly journals Major adverse events and atrial tachycardia in Ebstein’s anomaly predicted by cardiovascular magnetic resonance

Heart ◽  
2017 ◽  
Vol 104 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Riikka Rydman ◽  
Yumi Shiina ◽  
Gerhard-Paul Diller ◽  
Koichiro Niwa ◽  
Wei Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Volume Index ◽  
Ebstein’S Anomaly ◽  
Major Adverse Cardiovascular Events ◽  
Ebstein's Anomaly ◽  
First Onset

ObjectivesPatients with Ebstein’s anomaly of the tricuspid valve (EA) are at risk of tachyarrhythmia, congestive heart failure and sudden cardiac death. We sought to determine the value of cardiovascular magnetic resonance (CMR) for predicting these outcomes.MethodsSeventy-nine consecutive adult patients (aged 37±15 years) with unrepaired EA underwent CMR and were followed prospectively for a median 3.4 (range 0.4–10.9) years for clinical outcomes, namely major adverse cardiovascular events (MACEs: sustained ventricular tachycardia/heart failure hospital admission/cardiac transplantation/death) and first-onset atrial tachyarrhythmia (AT).ResultsCMR-derived variables associated with MACE (n=6) were right ventricular (RV) or left ventricular (LV) ejection fraction (EF) (HR 2.06, 95% CI 1.168 to 3.623, p=0.012 and HR 2.35, 95% CI 1.348 to 4.082, p=0.003, respectively), LV stroke volume index (HR 2.82, 95% CI 1.212 to 7.092, p=0.028) and cardiac index (HR 1.71, 95% CI 1.002 to 1.366, p=0.037); all remained significant when tested solely for mortality. History of AT (HR 11.16, 95% CI 1.30 to 95.81, p=0.028) and New York Heart Association class >2 (HR 7.66, 95% CI 1.54 to 38.20, p=0.013) were also associated with MACE; AT preceded all but one MACE, suggesting its potential role as an early marker of adverse outcome (p=0.011).CMR variables associated with first-onset AT (n=17; 21.5%) included RVEF (HR 1.55, 95% CI 1.103 to 2.160, p=0.011), total R/L volume index (HR 1.18, 95% CI 1.06 to 1.32, p=0.002), RV/LV end diastolic volume ratio (HR 1.55, 95% CI 1.14 to 2.10, p=0.005) and apical septal leaflet displacement/total LV septal length (HR 1.03, 95% CI 1.00 to 1.07, p=0.041); the latter two combined enhanced risk prediction (HR 6.12, 95% CI 1.67 to 22.56, p=0.007).ConclusionCMR-derived indices carry prognostic information regarding MACE and first-onset AT among adults with unrepaired EA. CMR may be included in the periodic surveillance of these patients.

scholarly journals Clinical and echocardiographic characteristics of patients with diabetic cardiomyopathy

2004 ◽  
Vol 61 (3) ◽  
pp. 259-266
Author(s):  
Zoran Perisic ◽  
Mirko Burazor ◽  
Goran Radjen ◽  
Lazar Todorovic ◽  
Zorka Burazor ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Cardiomyopathy ◽  
Insulin Dependent Diabetes Mellitus ◽  
Left Ventricular ◽  
Dependent Diabetes Mellitus ◽  
Control Group ◽  
Duration Of Diabetes ◽  
Left Ventricular Dimensions ◽  
Experimental Group ◽  
Ventricular Dimensions

The aim of this study was to evaluate clinical and echocardiographic characteristics of patients with diabetic cardiomyopathy. The study included 72 patients, divided into two groups. The experimental group consisted of 32 diabetics, while 40 gender and age-matched healthy subjects were in the control group. In the experimental group there were 17 patients with insulin-dependent diabetes mellitus, and 15 patients with non-insulin-dependent diabetes mellitus. The average duration of diabetes mellitus was 9.53 years. All the patients underwent the following diagnostic procedures: standard laboratory tests, 12-lead ECG, chest X-ray, 24-h Holter ECG, and complete echocardiographic examination. More frequent appearance of ventricular rhythm disturbances (65,6% vs. 47,5%), increased heart rate (78.3 ? 8.2 vs. 72.1 ? 4.6 beats per minute), and alteration of diastolic (56.25% vs. 12.5%) and systolic function (43.8% vs. 0%) was registered in patients with diabetes, compared to the control group. Experimental group was divided, according to their left ventricular dimensions, into two subgroups: the subgroup with normal left ventricular dimensions, and the subgroup with the increased left ventricular dimensions. Patients with the increased left ventricular dimensions not only had significantly lower ejection fraction (37.4 ? 7.0 vs. 61.3 ? 4.2%), but also had significantly longer duration of diabetes (12.6 ? 5.8 vs. 8.01 ? 3.01 years), worse quality of glycoregulation (13.1 ? 2.5 vs. 10.4 ? 2.1%), and higher Shapiro?s microvascular complications index (2.7 ? 1.26 vs. 0.68 ? 0.56). High degree of correlation was also found between the duration of diabetes left ventricular ejection fraction (-0.86), and left ventricular mass (0.86). The similar level of correlation was shown with Shapiro?s index (-0.77 and 0.88), as well as with morning glycaemia (-0.57 and 0.41). According to the obtained results it could be concluded that the changing rate of diabetic cardiomyopathy was in direct correlation with the quality of diabetes control, the duration of diabetes, and the presence of complications in other organs.

scholarly journals Incremental value of diastolic stress test in identifying subclinical heart failure in patients with diabetes mellitus

2020 ◽  
Vol 21 (8) ◽  
pp. 876-884 ◽  
Author(s):  
Tomoko Nishi ◽  
Yukari Kobayashi ◽  
Jeffrey W Christle ◽  
Nicholas Cauwenberghs ◽  
Kalyani Boralkar ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Stress Test ◽  
Left Ventricular ◽  
Metabolic Equivalents ◽  
Incremental Value ◽  
Asymptomatic Patients ◽  
Patients With Diabetes ◽  
Male Sex

Abstract Aims Resting echocardiography is a valuable method for detecting subclinical heart failure (HF) in patients with diabetes mellitus (DM). However, few studies have assessed the incremental value of diastolic stress for detecting subclinical HF in this population. Methods and results Asymptomatic patients with Type 2 DM were prospectively enrolled. Subclinical HF was assessed using systolic dysfunction (left ventricular longitudinal strain &lt;16% at rest and &lt;19% after exercise in absolute value), abnormal cardiac morphology, or diastolic dysfunction (E/e′ &gt; 10). Metabolic equivalents (METs) were calculated using treadmill speed and grade, and functional capacity was assessed by percent-predicted METs (ppMETs). Among 161 patients studied (mean age of 59 ± 11 years and 57% male sex), subclinical HF was observed in 68% at rest and in 79% with exercise. Among characteristics, diastolic stress had the highest yield in improving detection of HF with 57% of abnormal cases after exercise and 45% at rest. Patients with revealed diastolic dysfunction during stress had significantly lower exercise capacity than patients with normal diastolic stress (7.3 ± 2.1 vs. 8.8 ± 2.5, P &lt; 0.001 for peak METs and 91 ± 30% vs. 105 ± 30%, P = 0.04 for ppMETs). On multivariable modelling found that age (beta = −0.33), male sex (beta = 0.21), body mass index (beta = −0.49), and exercise E/e′ &gt;10 (beta = −0.17) were independently associated with peak METs (combined R2 = 0.46). A network correlation map revealed the connectivity of peak METs and diastolic properties as central features in patients with DM. Conclusion Diastolic stress test improves the detection of subclinical HF in patients with diabetes mellitus.

Analysis of midwall shortening reveals high prevalence of left ventricular myocardial dysfunction in patients with diabetes mellitus: the DYDA study

2011 ◽  
Vol 19 (5) ◽  
pp. 935-943 ◽  
Author(s):  
Giovanni Cioffi ◽  
Carlo B Giorda ◽  
Marcello Chinali ◽  
Andrea Di Lenarda ◽  
Pompilio Faggiano ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
High Prevalence ◽  
Patients With Diabetes

scholarly journals Hyperglycemic memory in diabetic cardiomyopathy

2021 ◽  
Author(s):  
Jiabing Zhan ◽  
Chen Chen ◽  
Dao Wen Wang ◽  
Huaping Li
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Blood Glucose ◽  
Cardiovascular Diseases ◽  
Glycemic Control ◽  
Diabetic Cardiomyopathy ◽  
Cardiovascular Complication ◽  
Diabetes Therapy ◽  
Patients With Diabetes ◽  
Underlying Mechanisms

AbstractCardiovascular diseases account for approximately 80% of deaths among individuals with diabetes mellitus, with diabetic cardiomyopathy as the major diabetic cardiovascular complication. Hyperglycemia is a symptom that abnormally activates multiple downstream pathways and contributes to cardiac hypertrophy, fibrosis, apoptosis, and other pathophysiological changes. Although glycemic control has long been at the center of diabetes therapy, multicenter randomized clinical studies have revealed that intensive glycemic control fails to reduce heart failure-associated hospitalization and mortality in patients with diabetes. This finding indicates that hyperglycemic stress persists in the cardiovascular system of patients with diabetes even if blood glucose level is tightly controlled to the normal level. This process is now referred to as hyperglycemic memory (HGM) phenomenon. We briefly reviewed herein the current advances that have been achieved in research on the underlying mechanisms of HGM in diabetic cardiomyopathy.

scholarly journals Addition of a β1-Blocker to Milrinone Treatment Improves Cardiac Function in Patients with Acute Heart Failure and Rapid Atrial Fibrillation

Cardiology ◽  
2019 ◽  
Vol 142 (4) ◽  
pp. 195-202
Author(s):  
Shigeki Kobayashi ◽  
Takeki Myoren ◽  
Toshiro Kajii ◽  
Michiaki Kohno ◽  
Takuma Nanno ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
New York ◽  
Cardiac Function ◽  
Acute Decompensated Heart Failure ◽  
Stroke Volume Index ◽  
Heart Association ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Volume Index

Background: Tachycardia worsens cardiac performance in acute decompensated heart failure (ADHF). We investigated whether heart rate (HR) optimization by landiolol, an ultra-short-acting β1-selective blocker, in combination with milrinone improved cardiac function in patients with ADHF and rapid atrial fibrillation (AF). Methods and Results: We enrolled9 ADHF patients (New York Heart Association classification IV; HR, 138 ± 18 bpm; left ventricular [LV] ejection fraction, 28 ± 8%; cardiac index [CI], 2.1 ± 0.3 L/min–1/m–2; pulmonary capillary wedge pressure [PCWP], 24 ± 3 mm Hg), whose HRs could not be reduced using standard treatments, including diuretics, vasodilators, and milrinone. Landiolol (1.5–6.0 µg/kg–1/min–1, intravenous) was added to milrinone treatment to study its effect on hemodynamics. The addition of landiolol (1.5 µg/kg–1/min–1) significantly reduced HR by 11% without changing systolic blood pressure (BP) and resulted in a significant decrease in PCWP and a significant increase in stroke volume index (SVI), suggesting that HR reduction restores incomplete LV relaxation. Administration of more than 3.0 µg/kg–1/min–1 of landiolol decreased BP, CI, and SVI. Conclusion: The addition of landiolol at doses of <3.0 µg/kg/min to milrinone improved cardiac function in decompensated chronic heart failure with rapid atrial fibrillation by selectively reducing HR.

Sign in / Sign up

Export Citation Format

Share Document