EFFECT OF ACUTE KETOACIDOSIS ON THE MYOCARDIUM IN DIABETES

Abnormalities of left ventricular function are often present in patien ts with diabetes who are in a stable metabolic state, To determine whe ther acute metabolic abnormalities may contribute to pathogenesis, pat ients with diabetes and ketoacidosis (Group 1) or hyperglycemia withou t ketosis (Group 2) were studied. They were assessed noninvasively for evidence of acute injury or dysfunction of the myocardium. Left ventr icular function was assessed on admission and after clinical recovery. Myocardial enzyme release was examined during the acute phase, In Gro up 1, plasma glucose averaged 32 mM/L and carbon dioxide content 12.4 mEq/L. On echocardiography, the initial circumferential shortening vel ocity of 1.85 + 0.07 circumferences per second was significantly highe r than the final circumferential shortening velocity of 1.31 + 01 (P ( 0.005), The systolic time interval ratio, pre-ejection period/left ve ntricular ejection time, was significantly lower on the initial day co mpared with the second study. These data are consistent with enhanced ventricular performance. In group 2, plasma glucose averaged 29 mM/L, and carbon dioxide content was normal. The initial circumferential sho rtening velocity of 1.1 circumferences per second and pre-ejection per iod/left ventricular ejection time ratio of 0.38 were normal and remai ned unchanged, There was no significant alteration of heart rate or ar terial pressure in either group, In both groups, total serum lactate d ehydrogenase and creatinine phosphokinase levels, as well as their car diac isoenzymes, were within normal limits, Therefore, the initial inc rease of myocardial performance and subsequent restoration to normal, as well as the lack of cardiac enzyme increase in plasma, support the view that short-term ketoacidosis does not contribute to the abnormali ties of ventricular function in diabetes.