Cardiac abnormalities in type 1 diabetes.
BACKGROUND
Left ventricular (LV) structural and hemodynamic consequences of type 1 diabetes mellitus are not fully understood.


METHODS
To evaluate LV geometry, systolic and diastolic function in type 1 diabetes, Doppler echocardiograms were performed in 40 normotensive, type 1 diabetic patients without coronary heart disease or valvular lesions (22 men, 18 women, mean age 43 +/- 6 years, body mass index 24.7 +/- 2.8 kg/m2) and in 40 age and sex-matched non-diabetic normotensive controls (22 men, 18 women, mean age 43 +/- 5 years, body mass index 23.2 +/- 2.8 kg/m2), in a case-control design.


RESULTS
Patients had higher systolic blood pressure than controls (p < 0.03) and comparable diastolic blood pressure and heart rate. LV dimension and mass were higher in patients than in controls (both p < 0.0001) whereas relative wall thickness did not differ. For comparable levels of end-systolic stress, patients exhibited a higher ejection fraction than controls (p < 0.01) and normal midwall shortening. Cardiac output was also higher (p < 0.001), whereas total peripheral resistance was lower in patients than in controls (p < 0.0001). Isovolumic relaxation time and E deceleration were prolonged in patients and peak A velocity was greater than in controls (all p < 0.01), whereas the difference in duration between A and pulmonary vein peak reverse flow at atrial contraction was comparable. In subgroup analyses, all reported features were independent of a) presence of target organ damage; b) duration of disease; c) levels of glycosylated hemoglobin.


CONCLUSIONS
In normotensive patients with type 1 diabetes: 1) there was a moderate increase in LV mass; 2) LV chamber function was supernormal and wall mechanics was normal; 3) LV active relaxation was impaired but chamber stiffness was normal.
Department of Clinical and Experimental Medicine, Federico II, University Hospital School of Medicine, Naples, Italy. simogi@unina.it
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de Simone
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Mureddu
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Vaccaro
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Greco
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Sacco
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Rivellese
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Contaldo
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Riccardi
D000328:Adult; D001794:Blood Pressure; D002302:Cardiac Output; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D013318:Stroke Volume; D014655:Vascular Resistance; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology