title: Diastolic dysfunction in patients with type 2 diabetes mellitus: is it really the first marker of diabetic cardiomyopathy?
abstract: BACKGROUND
  Diastolic dysfunction is considered the first marker of diabetic cardiomyopathy. However, preclinical systolic alteration was also recently described by strain, but its association with diastolic dysfunction has never been investigated.
  
  
  METHODS
  One hundred fourteen patients with type 2 diabetes mellitus (DM) with controlled blood pressure and without overt heart disease were prospectively enrolled and compared with 88 age-matched controls. All subjects underwent comprehensive echocardiography, including diastolic evaluation according to current recommendations and speckle-tracking imaging. The prevalence of diastolic dysfunction, the determinants of diastolic parameters, and the association between preclinical systolic and diastolic dysfunctions were studied.
  
  
  RESULTS
  Diastolic parameters were altered in patients compared with controls, with lower E/A ratios, longer mitral deceleration and isovolumic relaxation times, and higher E/e' ratio. Diastolic dysfunction occurred in 47% of patients with DM (33% and 14% with grade I and II diastolic dysfunction, respectively) and systolic alteration (longitudinal strain ≥ -18%) in 32% of patients. Whereas longitudinal systolic strain was independently associated with DM and gender, diastolic parameters were influenced by many factors, including age, rate-pressure product, history of hypertension, and body mass index. Systolic alteration occurred in 28% of patients with DM with normal diastolic function and in 35% with diastolic dysfunction.
  
  
  CONCLUSIONS
  Diastolic dysfunction diagnosed according to current recommendations is frequent in patients with DM but is also influenced by other factors. Systolic strain alteration may exist despite normal diastolic function, indicating that diastolic dysfunction should not be considered the first marker of a preclinical form of diabetic cardiomyopathy.
authors: Service des Explorations Fonctionnelles Cardiovasculaires, Louis Pradel Hospital, Lyon, France.
authors: Laura
authors: L
authors: Ernande
authors: Cyrille
authors: C
authors: Bergerot
authors: Ernst R
authors: ER
authors: Rietzschel
authors: Marc L
authors: ML
authors: De Buyzere
authors: Hélène
authors: H
authors: Thibault
authors: Pierre Gautier
authors: PG
authors: Pignonblanc
authors: Pierre
authors: P
authors: Croisille
authors: Michel
authors: M
authors: Ovize
authors: Laure
authors: L
authors: Groisne
authors: Philippe
authors: P
authors: Moulin
authors: Thierry C
authors: TC
authors: Gillebert
authors: Geneviève
authors: G
authors: Derumeaux
mesh_terms: D000328:Adult; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000503:physiopathology*; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D003971:Diastole / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D014463:Ultrasonography; D018754:Ventricular Dysfunction / Q000145:classification / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology