title: Quantification of diastolic dysfunction via the age dependence of diastolic function - impact of insulin resistance with and without type 2 diabetes.
abstract: BACKGROUND
  The alarming prevalence of heart failure with preserved ejection fraction requires quantification of diastolic dysfunction (DDF). Myocardial diastolic velocity E' implies that age is the most important determinant. We tested the hypothesis that age allows for quantification of DDF and assessment of the structural and metabolic determinants in patients with and without type 2 diabetes (D).
  
  
  METHODS
  This prospective, cross-sectional study assessed cardiovascular, metabolic and ultrasound data in 409 consecutive patients (Diabetes Center, Bogenhausen-Munich) between 20 and 90 years without known cardiac disease and either with (n=204) or without D but with common prevalence of cardiovascular risk factors, including a subgroup of healthy individuals (H, n=94).
  
  
  RESULTS
  In H, E' related to age as: E'norm=-0.163∗years+19.69 (R(2)=0.77, p<0.0001). According to this 1% reduction by annual physiologic aging, DDF was quantitated as E'-E' norm. Compared to nondiabetics, D patients were older, had greater BMI, lower E', more cardiovascular risk and greater DDF. In nondiabetics, grading of DDF by E-E'norm correlated with grading by filling pressure E/E'. Determinants of DDF by multivariate analysis included pulse wave velocity, diastolic blood pressure and the triglyceride/HDL ratio (a marker of insulin resistance) in nondiabetics and in D the same risk factors in reverse sequence and heart rate. Neither left atrial size nor left ventricular mass had significant impact.
  
  
  CONCLUSIONS
  The physiological impact of age on myocardial function consists of a 1% annual reduction in E' and enables precise quantification of diastolic dysfunction thereby unmasking the importance of metabolic risk for DDF.
authors.affiliation: Clinic for Endocrinology, Diabetes & Vascular Medicine, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Munich, Germany. Electronic address: vonbibra@gmx.de.
authors.forename: H
authors.initials: H
authors.lastname: von Bibra
authors.affiliation: Institute for Cardiovascular Research Vrije Universiteit, VU University Medical Center Amsterdam, Amsterdam, the Netherlands.
authors.forename: W J
authors.initials: WJ
authors.lastname: Paulus
authors.affiliation: Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: M
authors.initials: M
authors.lastname: St John Sutton
authors.affiliation: Clinic for Endocrinology, Diabetes & Vascular Medicine, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Leclerque
authors.affiliation: Institute for Statistics and Epidemiology in Medicine of the Technische Universität, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Schuster
authors.affiliation: Clinic for Endocrinology, Diabetes & Vascular Medicine, Klinikum Bogenhausen, Städt. Klinikum München GmbH, Munich, Germany.
authors.forename: P-M
authors.initials: PM
authors.lastname: Schumm-Draeger
mesh_terms: D000367:Age Factors; D015897:Comorbidity / Q000639:trends; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D014943:Global Health; D054144:Heart Failure, Diastolic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D007333:Insulin Resistance; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*
keywords: Diastolic dysfunction; Heart failure preserved ejection fraction; Insulin resistance; Metabolic cardiomyopathy; Tissue Doppler; Type 2 diabetes