ISOLATED AND PRECLINICAL IMPAIRMENT OF LEFT-VENTRICULAR FILLING IN INSULIN-DEPENDENT AND NON-INSULIN-DEPENDENT DIABETIC-PATIENTS

Background: Diabetes mellitus can induce a pattern of myocardial patho logy known as specific diabetic cardiomyopathy, even if this is not cl early specified.Hypothesis: The aim of our study was to evaluate the p resence of preclinical myocardial damage in insulin- and non-insulin-d ependent diabetic patients and controls by assessment with Doppler ech ocardiography. Methods: Twenty insulin-dependent diabetic (IDDM) patie nts, 10 non-insulin-dependent diabetic (NIDDM) patients, and 12 health y individuals (C) as controls, matched for age, gender, and without ov ert cardiovascular disease, were assessed in this study. Results: Syst olic function parameters presented normal values in the three groups, with the exception of a slight reduction in ventricular volume indices in the NIDDM group. Diastolic function was clearly impaired in both g roups of patients versus that in healthy controls. In particular, vent ricular filling was impaired in the NIDDM compared with the IDDM patie nts, especially the peak early filling rate E (p<0.001). Moreover, in the IDDM group, the duration of diabetes (p<0.01) and glycosilated hem oglobin value (HbA1C, p<0.02) were higher than in the NIDDM group. Mul tiple regression analysis showed a significant inverse correlation bet ween HbA1C and peak late filling rate A (R2 = 0.28) in both groups of patients and a direct correlation between velocity time integral E and age, duration of diabetes, and HbA1C (R-2 = 0.46). The two groups pre sented a small, homogeneous number of cases with initial microangiopat hy and borderline autonomic neuropathy, associated with microalbuminur ia. Doppler echocardiography showed an early impairment of left ventri cular filling, as well as an early preclinical alteration of myocardia l function in diabetic patients, especially in the NIDDM group. Conclu sion: These early signs of cardiomyopathy could constitute a predispos ing condition toward the high cardiac morbidity and mortality rate in diabetic patients.