Document Detail

Uncomplicated type 1 diabetes and preclinical left ventricular myocardial dysfunction: insights from echocardiography and exercise cardiac performance evaluation.
MedLine Citation:
PMID:  17996323     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Left ventricular (LV) diastolic dysfunction is considered the earliest manifestation of diabetic cardiomyopathy. Whether LV abnormalities identified at rest by echocardiography predict peak exercise LV performance in uncomplicated type 1 diabetes mellitus (DM1) is largely unknown. RESEARCH DESIGN AND METHODS: We evaluated LV size, mass, and functions and peak exercise LV performance in 25 subjects with uncomplicated DM1 (median disease duration 13.5 years, 1-30 years) and in 56 non-DM subjects (24 hypertensive (HT) and 32 normotensive (NT)). Overt coronary heart disease, significant microangiopathy and central autonomic neuropathy were minimized by exclusion criteria. Peak exercise LV stroke index (SVi), cardiac index (COi), LV ejection fraction (EF), LV end-diastolic and end-systolic volumes were assessed noninvasively. No subject was on cardiovascular medications at the time of evaluation. RESULTS: In our study, DM1 did not show LV hypertrophy or impaired LV systolic function at rest. Prevalence of diastolic dysfunction was 8% among DM1, 18% among NT and 50% among HT. Pre-exercise heart rate, SVi, COi, and peak exercise blood pressure (BP) and heart rate were comparable among the three groups, but peak exercise LV EF, SVi and COi were lower in DM1 than in HT and NT independent to covariates (p<0.05). In separate analyses, DM1 predicted lower peak exercise SVi (B=-6.2) and COi (B=-1.6, both p<0.05) independently. Within DM1, glycated haemoglobin (HbA1c) and disease duration did not predict peak exercise LV systolic function. CONCLUSIONS: Our study suggests that uncomplicated DM1 may be associated with subnormal LV contractility reserve, which might not be predicted by LV dysfunction evaluated at rest.
Vittorio Palmieri; Brunella Capaldo; Cesare Russo; Michele Iaccarino; Salvatore Pezzullo; Gabriele Quintavalle; Giovanni Di Minno; Gabriele Riccardi; Aldo Celentano
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Publication Detail:
Type:  Journal Article     Date:  2007-11-08
Journal Detail:
Title:  Diabetes research and clinical practice     Volume:  79     ISSN:  1872-8227     ISO Abbreviation:  Diabetes Res. Clin. Pract.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-01     Completed Date:  2008-03-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8508335     Medline TA:  Diabetes Res Clin Pract     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  262-8     Citation Subset:  IM    
Division of Cardiology, Ospedale dei Pellegrini, ASL-Napoli 1, Naples, Italy.
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MeSH Terms
Diabetes Mellitus, Type 1 / physiopathology*
Diabetic Angiopathies / physiopathology*,  ultrasonography
Exercise Test*
Hypertension / physiopathology,  ultrasonography
Middle Aged
Ventricular Dysfunction, Left / physiopathology*,  ultrasonography

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