LEFT-VENTRICULAR FILLING IN YOUNG-PATIENTS AFFECTED BY INSULIN-DEPENDENT DIABETES-MELLITUS - A STRESS DOPPLER-ECHOCARDIOGRAPHIC STUDY

Background. The purpose of this study was to analyze diastolic functio n in two different populations of young patients affected by insulin d ependent diabetes mellitus (IDDM), with and without systemic diabetic complications, and to compare the results obtained at rest with those obtained during isometric exercise. Methods. Forty-five IDDM diabetic patients were studied. On the basis of presence or absence of systemic diabetic complications (nephropathy and retinopathy) patients were di vided into two groups. Group I (20 patients) without and Group II (25 patients) with diabetic complications. Diastolic function parameters w ere measured by Doppler echocardiography at rest and during isometric exercise. The two groups were similar regarding age, metabolic control and insulin dosage but there were significant differences in diastoli c and systolic blood pressure and heart rate between the two groups, t he patients with complications showing higher values (p < 0.001, p < 0 .005, p < 0.01 respectively). Results. Group II already presented at r est alterations of diastolic function parameters respect to Group I wi th a marked increase of: peak velocity of late left ventricular fillin g (peakA cm/sec), (60.1 +/- 13.4 versus 48.4 +/- 8.9, p < 0.01); late left ventricular filling integral (A area), (6.5 +/- 1.4 versus 5.0 +/ - 0.8, p < 0.05); late left ventricular filling integral over total fi lling (A area/total area), (0.31 +/- 0.06 versus 0.26 +/- 0.06, p < 0. 01). There was a decrease of E/A ratio in Group IT versus Group I (1.5 +/- 0.32 versus 1.9 +/- 0.5, p < 0.05). During isometric exercise the se changes became even more pronounced in patients with complications and in this group there was a marked decrease of flow integral of earl y left ventricular filling over total filling (E area/total area), (0. 57 +/- 0.09 versus 0.68 +/- 0.07, p < 0.01). Conclusions. In conclusio n, young IDDM patients with complications show an impairment of diasto lic function more pronounced than those without. These changes are mor e evident during isometric exercise. Stress Doppler echocardiography i s a reliable tool to detect early diastolic dysfunction in diabetic pa tients.