title: Identification of a definite diabetic cardiomyopathy in type 2 diabetes by comprehensive echocardiographic evaluation: A cross-sectional comparison with non-diabetic weight-matched controls.
abstract: BACKGROUND
  Subclinical left ventricular (LV) dysfunction is prevalent in type 2 diabetes (T2DM). As obesity has been proposed as one causal factor in the disease process, this could bias the reported prevalences. We wanted to characterize echocardiographic LV dysfunction in obese T2DM subjects as compared to non-diabetic obese controls.
  
  
  METHODS
  One hundred patients with T2DM without clinical signs of heart failure (29% females, mean ± SD age 58.4 ± 10.5 years, body mass index (BMI) 30.1 ± 5.5 kg/m(2), blood pressure (BP) 141 ± 18/83 ± 9 mmHg) and 100 non-diabetic controls (29% females) matched for age (58.6 ± 10.5 years), BMI (29.8 ± 4.0 kg/m(2) and systolic BP (140 ± 14 mmHg) underwent echocardiography and color tissue Doppler imaging (TDI). Diastolic function was evaluated with conventional Doppler recordings and early (e') and late (a') myocardial velocities. The ratio between early transmitral filling (E) and the corresponding myocardial tissue velocity (e') served as an index of LV filling pressure.
  
  
  RESULTS
  T2DM patients had more concentric hypertrophy with a relative wall thickness of 0.42 ± 0.07 vs controls 0.38 ± 0.07, P < 0.001. The T2DM group had signs of diastolic dysfunction with lower E/A ratio (0.91 ± 0.27 vs. 1.12 ± 0.38, P < 0.001), deceleration time (195 ± 49 vs 242 ± 72 ms, P < 0.001), e' (5.7 ± 2.0 vs. 6.6 ± 1.8 cm/s, P = 0.001), and a' (6.5 ± 2.0 vs. 7.6 ± 1.5 cm/s, P < 0.001) compared to the controls, and higher E/e' (13.3 ± 4.7 vs. 11.1 ± 3.5, P < 0.001). Thus, there were indications of pseudo normalization and increased filling pressure in the T2DM group, whereas the controls had evidence for relaxation abnormalities without elevated filling pressure.
  
  
  CONCLUSIONS
  Compared to a non-diabetic obese group, more advanced subclinical impairment of diastolic function was seen in T2DM.
authors.affiliation: Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Baerum, Norway.
authors.forename: Anne Pernille
authors.initials: AP
authors.lastname: Ofstad
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Stig
authors.initials: S
authors.lastname: Urheim
authors.affiliation: MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Håvard
authors.initials: H
authors.lastname: Dalen
authors.affiliation: Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Baerum, Norway.
authors.forename: Elsa
authors.initials: E
authors.lastname: Orvik
authors.affiliation: Department of Endocrinology, Morbid Obesity and Preventive Disease, Oslo University Hospital Aker, Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Kåre I
authors.initials: KI
authors.lastname: Birkeland
authors.affiliation: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.|K.G. Jebsen Cardiac Research Centre and Center for Heart Failure Research, Oslo Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.affiliation: Unit of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Morten
authors.initials: M
authors.lastname: W Fagerland
authors.affiliation: Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Baerum, Norway.
authors.forename: Odd Erik
authors.initials: OE
authors.lastname: Johansen
authors.affiliation: MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D003971:Diastole; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D017725:Ventricular Pressure
keywords: diabetic cardiomyopathy; echocardiography; left ventricular dysfunction; obesity; type 2 diabetes mellitus; 关键词：糖尿病性心肌病，超声心动图，左心室功能不全，肥胖，2型糖尿病