Left ventricular diastolic function in type 2 diabetes mellitus: prevalence and association with myocardial and vascular disease.
BACKGROUND
Although type 2 diabetes mellitus is a risk factor for developing congestive heart failure, the mechanism leading to heart failure is unclear. We examined the prevalence of left ventricular (LV) systolic and diastolic dysfunction in patients with type 2 diabetes mellitus in relation to vascular function and myocardial perfusion.


RESULTS
A prospective observational study of 305 patients with type 2 diabetes mellitus (diabetes duration, 4.5+/-5.3 years) referred consecutively to a diabetes clinic were screened for LV systolic and diastolic function by echocardiography. Vascular function was estimated using noninvasive estimation of pulse pressure, carotid arterial compliance, total arterial compliance, and valvulo-arterial impedance. The prevalences of LV diastolic dysfunction and left atrial (LA) volume index >32 mL/m(2) were 40% and 32%, respectively. The prevalence of myocardial ischemia on myocardial perfusion scintigraphy was more frequent in patients with grade 2 diastolic dysfunction and LA volume index >32 mL/m(2) compared with those having normal or grade 1 diastolic dysfunction (P=0.002) or LA volume index < or =32 mL/m(2) (P<0.001), respectively. Predictors of grade 2 diastolic dysfunction and LA dilation were summed stress score on myocardial perfusion scintigraphy, total arterial compliance, and valvulo-arterial impedance, whereas pulse pressure and carotid arterial compliance were not, after adjusting for age, sex, and diabetes duration. On multivariable modeling, summed stress score (P<0.001) and valvulo-arterial impedance (P=0.027) remained predictors of grade 2 diastolic dysfunction, and only summed stress score (P<0.001) was a predictor of LA dilation.


CONCLUSIONS
Abnormal LV filling is closely associated with abnormal myocardial perfusion on myocardial perfusion scintigraphy, whereas the association of LV filling with vascular function is less prominent.
Poulsen
Mikael Kjaer
MK
Departments of Endocrinology, Nuclear Medicine, and Cardiology, Odense University Hospital, Kløvervaenget 6, Odense, Denmark. mikael.kjaer.poulsen@ouh.regionsyddanmark.dk
Henriksen
Jan Erik
JE
Dahl
Jordi
J
Johansen
Allan
A
Gerke
Oke
O
Vach
Werner
W
Haghfelt
Torben
T
Høilund-Carlsen
Poul Flemming
PF
Beck-Nielsen
Henning
H
Møller
Jacob Eifer
JE
D000368:Aged; D001011:Aorta / Q000503:physiopathology; D002339:Carotid Arteries / Q000503:physiopathology; D003187:Compliance; D003326:Coronary Circulation; D003718:Denmark / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D003971:Diastole; D004108:Dilatation, Pathologic; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left