title: Left ventricular diastolic reserve in patients with type 2 diabetes mellitus.
abstract: Diastolic reserve is the ability of left ventricular filling pressures to remain normal with exercise. Impaired diastolic reserve may be an early sign of diabetic cardiomyopathy. We aimed to determine whether diastolic reserve differs in type 2 diabetes (DM) compared with non-DM, and to identify clinical, anthropological, metabolic and resting echocardiographic correlates of impaired diastolic reserve in patients with DM.
  
  
  
  237 patients (aged 53±11 years, 133 DM, ejection fraction 68±9%) underwent rest and exercise echocardiography. Mitral E and septal e' were measured at rest, immediately post, and 10 min into recovery. Analysis of covariance (ANCOVA) and binary regression with continuous outcomes were used to model e' and E/e' changes with exercise to identify impaired diastolic reserve defined as post-exercise E/e' ≥15. After adjusting for baseline differences, patients with DM immediately post-exercise had a lower septal e', a lower Δe' (1.2 vs 2.3 cm/s, p=0.006) and a higher Δ septal E/e' (1.7 vs 0.08, p<0.001) than patients without DM. In patients with normal resting E/e' of ≤8 (n=130), DM had a significantly higher post-exercise septal E/e' and a higher Δseptal E/e' (2.63 vs 0.50, p<0.001). E/e' in patients with DM remained significantly elevated up to 10 min post-exercise. Hypertension, longer duration of insulin therapy, poorer glycaemic control, worse renal function, larger left atrial volume and lower septal e' were independent correlates of impaired diastolic reserve in patients with DM.
  
  
  
  Patients with DM have impaired diastolic reserve manifest as a blunted e' response with exercise, persisting into recovery. Clinical, anthropometric, metabolic and echocardiographic correlates of impaired diastolic reserve in patients with DM were identified. An impaired LV diastolic reserve may be the underlying pathophysiological mechanism in patients with DM with unexplained exertional dyspnoea and may allow earlier detection of DM cardiomyopathy.
authors.affiliation: Department of Cardiology , Liverpool Hospital, University of New South Wales , Sydney, New South Wales , Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Leung
authors.affiliation: Department of Cardiology , Liverpool Hospital, University of New South Wales , Sydney, New South Wales , Australia.
authors.forename: Victoria
authors.initials: V
authors.lastname: Phan
authors.affiliation: Department of Cardiology , Liverpool Hospital, University of New South Wales , Sydney, New South Wales , Australia.
authors.forename: Melinda
authors.initials: M
authors.lastname: Whatmough
authors.affiliation: The George Institute, University of Sydney , Camperdown, New South Wales , Australia.
authors.forename: Stephane
authors.initials: S
authors.lastname: Heritier
authors.affiliation: Liverpool Diabetes Collaborative Research Unit, Ingham Institute, Liverpool, Sydney, New South Wales , Australia ; University of New South Wales, Sydney, New South Wales , Australia.
authors.forename: Vincent W
authors.initials: VW
authors.lastname: Wong
authors.affiliation: Department of Cardiology , Liverpool Hospital, University of New South Wales , Sydney, New South Wales , Australia.
authors.forename: Dominic Y
authors.initials: DY
authors.lastname: Leung