[Early decrease in diastolic function in young type I diabetic patients as an initial manifestation of diabetic cardiomyopathy].
BACKGROUND
The early determination of the myocardial manifestation is of considerable importance, since the prognosis of patients (P) with insulin dependent diabetes mellitus (IDDM) is generally masked by secondary cardiac complications. The aim of this study was to investigate whether young, asymptomatic P with IDDM and persisting normal systolic left ventricular (LV) function already show a diastolic LV dysfunction.


METHODS
An echocardiographical examination of 92 IDDM patients (age: 25 +/- 4 years) without known cardiac disease and of 50 control persons (C) of similar ages was carried out. P with a cardiac disease or long-term diabetic syndrome were excluded. Using M-mode echocardiography, morphological parameters and systolic time-intervals (fractional shortening; ejection fraction) were determined. Doppler indices were then measured: maximal early and late diastolic flow velocity (VE; VA), E/A ratio, acceleration and deceleration time (DT), isovolumetric relaxation time (IVRT).


RESULTS
Although the left atrial and left ventricular dimensions, as well as the systolic functional parameters of all P with IDDM were normal, they showed a diastolic dysfunction with a reduction of the early diastolic filling (VE; 0.54 +/- 0.07 m/s vs 0.72 +/- 0.04 m/s; p < 0.01) and the E/A ratio (0.9 +/- 0.15 vs 1.99 +/- 0.22; p < 0.01), an increase in the atrial filling (VA; 0.76 +/- 0.05 m/s vs 0.39 +/- 0.04 m/s, p < 0.01), an extension of the IVRT (129 +/- 23 ms vs 78 +/- 6 ms, p < 0.01), and an increased DT (248 +/- 27 ms vs 188 +/- 8 ms, p < 0.01).


CONCLUSIONS
Even young P with IDDM, with a normal systolic ventricular function, suffer a diastolic dysfunction which serves as a marker of a diabetic cardiomyopathy. Therefore, echocardiography with measurements of systolic and diastolic functional parameters appears to be a sensible method for evaluating the course of diabetic cardiomyopathy.
Medizinische Klinik, Heinrich-Heine-Universität Düsseldorf.
C M
CM
Schannwell
F C
FC
Schoebel
S
S
Heggen
R
R
Marx
C
C
Perings
M
M
Leschke
B E
BE
Strauer
D000328:Adult; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003971:Diastole / Q000502:physiology*; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012680:Sensitivity and Specificity; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology
Frühzeitige Einschränkung der diastolischen Funktion bei jungen Typ-I-Diabetikern als Erstmanifestation einer diabetischen Herzmuskelerkrankung.