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Diastolic Dysfunction in Normotensive Men with Well-Controlled Type 2 Diabetes

Importance of maneuvers in echocardiographic screening for preclinical diabetic cardiomyopathy

  1. Paul Poirier, MD, FRCPC,
  2. Peter Bogaty, MD, FRCPC,
  3. Caroline Garneau, MSC,
  4. Louise Marois, RT and
  5. Jean-G. Dumesnil, MD, FRCPC, FACC
  1. From the Quebec Heart Institute and Laval Hospital, Sainte-Foy, Quebec, Canada.
  1. Address correspondence and reprint requests to Paul Poirier, MD, FRCPC, Quebec Heart Institute/Laval Hospital, 2725 Chemin Sainte-Foy, Sainte-Foy, Quebec, Canada, G1V 4G5. E-mail: paul.poirier{at}crhl.ulaval.ca .

Abstract

OBJECTIVE— Because a pseudonormal pattern of ventricular filling has never been considered in studies that reported a prevalence of left ventricular diastolic dysfunction (LVDD) between 20 and 40%, our aim was to more completely evaluate the prevalence of LVDD in subjects with diabetes.

RESEARCH DESIGN AND METHODS— We studied 46 men with type 2 diabetes who were aged 38-67 years; without evidence of diabetic complications, hypertension, coronary artery disease, congestive heart failure, or thyroid or overt renal disease; and with a maximal treadmill exercise test showing no ischemia. LVDD was evaluated by Doppler echocardiography, which included the use of the Valsalva maneuver and pulmonary venous recordings to unmask a pseudonormal pattern of left ventricular filling.

RESULTS— LVDD was found in 28 subjects (60%), of whom 13 (28%) had a pseudonormal pattern of ventricular filling and 15 (32%) had impaired relaxation. Systolic function was normal in all subjects, and there was no correlation between LVDD and indexes of metabolic control.

CONCLUSIONS— LVDD is much more common than previously reported in subjects with well-controlled type 2 diabetes who are free of clinically detectable heart disease. The high prevalence of this phenomenon in this high-risk population suggests that screening for LVDD in type 2 diabetes should include procedures such as the Valsalva maneuver and pulmonary venous recordings to unmask a pseudonormal pattern of ventricular filling.

Footnotes

  • Abbreviations: CAD, coronary artery disease; IVRT, isovolumetric relaxation time; LVDD, left ventricular diastolic dysfunction; MET, metabolic equivalent; PST, posterior wall thickness; PVa, pulmonary reversed A wave velocity; PVd, pulmonary D wave velocity; PVs, pulmonary S wave velocity.

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted August 22, 2000.
    • Received April 4, 2000.
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