title: Diastolic dysfunction in diabetic patients assessed with Doppler echocardiography: relationship with coronary atherosclerotic burden and microcirculatory impairment.
abstract: OBJECTIVE
  Diabetes mellitus (DM) is associated with the development of both impaired left ventricular diastolic function (LVDF) and pathological changes in the coronary macro- and microcirculation. The aim of this study was to investigate the relationship between these manifestations of diabetic heart disease.
  
  
  METHODS
  The severity of atherosclerosis in the left anterior descending coronary artery (LAD) was quantified using intravascular ultrasound (IVUS) in 13 patients with DM and ischemic heart disease. The coronary flow velocity reserve (CFVR), instantaneous hyperemic diastolic velocity pressure slope index (IHDVPS) and zero-flow pressure were derived from digital intracoronary pressure and flow velocity measurements. The relationships between indices of LVDF (i.e. E/A and E/e' ratios) and intracoronary measurements were assessed.
  
  
  RESULTS
  The left ventricular ejection fraction was 66+/-7%, and the LVDF indices were: E/A=0.92+/-0.38 and E/e'=9.90+/-2.80. There was a direct proportional relationship (r=0.62; P=.02) between E/e' and coronary resistance (1.93+/-0.74 mmHg/s) and an inverse proportional relationship (r=-0.64; P=.02) between E/e' and IHDVPS (1.56+/-0.50 cm/s/mmHg). However, no significant relationship was found between either LVDF index and CFVR (2.43+/-0.56) or coronary zero-flow pressure (40.41+/-10.66 mmHg). The volume of atheroma in the proximal 20 mm of the LAD (179.34+/-57.48 .l, with an average plaque area of 8.39+/-2.20 mm2) was not related to either LVDF index.
  
  
  CONCLUSIONS
  In patients with DM and coronary atherosclerosis, there appeared to be a relationship between LVDF impairment (assessed by the E/e' ratio) and structural changes in the microcirculation.
authors.affiliation: Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, España. escaned@secardiologia.es
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.forename: Humberto
authors.initials: H
authors.lastname: Colmenárez
authors.forename: María Cruz
authors.initials: MC
authors.lastname: Ferrer
authors.forename: Marcos
authors.initials: M
authors.lastname: Gutiérrez
authors.forename: Pilar
authors.initials: P
authors.lastname: Jiménez-Quevedo
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
authors.forename: Camino
authors.initials: C
authors.lastname: Bañuelos
authors.forename: Leopoldo Pérez
authors.initials: LP
authors.lastname: Deisla
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
mesh_terms: D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003326:Coronary Circulation; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*