Doppler-echocardiography as a means of early determination of diabetic cardiomyopathy for patients with diabetes mellitus type I

Introduction: The early determination of the myocardial manifestation is of considerable importance, since the prognosis of patients (P) with insulin dependent diabetes mellitus (IDDM) is generally masked by secondary cardiac complications. The aim of this study was to investigate whether young, asy mptomatic P with IDDM and persisting normal systolic left ventricular (LV) function already show a diastolic LV dysfunction. Methods: An echocardiographical examination of 92 IDDM patients (age: 25 +/ - 4 years) without known cardiac disease and of 50 control persons (C) of s imilar ages was carried out. P with a cardiac disease or long-term diabetic syndrome were excluded. Using M-mode echocardiography, morphological param eters and systolic time-intervals (fractional shortening; ejection fraction ) were determined. Doppler indices were then measured: maximal early and la te diastolic flow velocity (VE; VA), E/A ratio, acceleration and decelerati on time (DT), isovolumetric relaxation time (IVRT). Results. Although the left atrial. and left ventricular dimensions, as well as the systolic functional parameters of all P with IDDM were normal, they showed a diastolic dysfunction with a reduction of the early diastolic fil ling (V-B; 0.54 +/- 0,07 m/s vs 0.72 +/- 0.04 m/s; p < 0.01) and the E/A ra tio (0.9 +/- 0.15 vs 1.99 +/- 0.22; p < 0.01), an increase in the atrial fi lling (V-A; 0.76 +/- 0.05 m/s vs 0.39 +/- 0.04 m/s, p < 0.01), an extension of the IVRT (129 +/- 23 ms vs 78 +/- 6 ms, p < 0.01), and an increased DT (248 +/- 27 ms vs 188 +/- 8 ms, p < 0.01). Conclusion: Even young P with IDDM, with a normal systolic ventricular func tion, suffer a diastolic dysfunction which serves as a marker of a diabetic cardiomyopathy. Therefore, echocardiography with measurements of systolic and diastolic functional parameters appears to be a sensible method for eva luating the course of diabetic cardiomyopathy.