Impaired myocardial function in newly onset type 2 diabetes associates with arterial stiffness.
OBJECTIVE
The aim of this study was to evaluate myocardial function using pulsed and color-coded tissue Doppler imaging (TDI) and vascular wall elasticity using whole-body impedance cardiography (ICG) in patients with newly diagnosed Type 2 diabetes mellitus (DM2), and to compare the measurements with those of healthy controls.


METHODS
Systolic (SBP) and diastolic (DBP) blood pressure and glycosylated hemoglobin (HbA1c) were measured in 49 men (mean age 52.3+/-5.6 years, duration of DM2 1.8 years), and 15 healthy male control subjects (48.3+/-7.4 years). Mitral annular peak systolic (Svm), early (Evm), and late (Avm) diastolic velocities as well as myocardial peak systolic (Sv), early (Ev) and late diastolic (Av) velocity from middle segments of the anterior, inferior and lateral wall and the inferior septum were measured by TDI. ICG at rest was used to measure cardiac index (CI) and pulse wave velocity (PWV).


RESULTS
The patients had higher body mass index (BMI 29.1+/-3.7 vs. 25.2+/-2.4 kg/m(2), p=0.000) and SBP (142+/-15 vs. 120+/-7 mmHg, p=0.005) than the controls, CI was comparable (2.8+/-0.5 vs. 2.8+/-0.6l/min/m(2)). The patients had lower age adjusted myocardial Sv (3.8+/-1.1 vs. 4.8+/-1.1cm/s, p=0.002) and Ev (4.6+/-1.6 vs. 6.2+/-1.7 cm/s, p=0.011), and also mitral annulus peak early diastolic velocity (Evm 7.8+/-1.9 vs. 10.4+/-2.6 cm/s, p=0.001). In diabetic patients PWV (14.2+/-2.7 vs. 10.0+/-1.7 m/s, p=0.002) was higher. Age (r=-0.39, p=0.001), BMI (r=-0.44, p=0.000) and PWV (r=-0.52, p=0.000) correlated significantly with Evm. PWV correlated with age (r=0.50, p=0.000), SBP (r=0.67, p=0.000), and HBA1c (r=0.36, p=0.010). In stepwise regression analysis, PWV (beta=-0.39, p=0.000) was the major determinant of Evm.


CONCLUSIONS
Myocardial function is impaired in asymptomatic patients with newly detected DM2 consistent with diabetic heart muscle disease. Arterial stiffness is strongly related to myocardial dynamics, and both may have the same pathophysiologic background.
Loimaala
Antti
A
Clinical Physiology and Nuclear Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, 60220 Seinäjoki, Finland. seanlo@uta.fi
Groundstroem
Kaj
K
Majahalme
Silja
S
Nenonen
Arja
A
Vuori
Ilkka
I
D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002307:Cardiography, Impedance; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D018619:Echocardiography, Doppler, Pulsed; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D013318:Stroke Volume; D014655:Vascular Resistance
D015415:Biomarkers