Cardiac abnormalities in a prospective study of 40 patients with type 2 diabetes.

Cardiovascular mortality, the principal cause of early death in diuretics, is multifactorial. A prospective study was:undertaken to analyse the differ ent factors of excess cardiac complications in 40 patients with type 2 diab etes, whatever the symptomatology, by making an inventory of the cardiac ab normalities (systolic and diastolic left ventricular function, left ventric ular hypertrophy, abnormalities of myocardial perfusion, heart rate variabi lity and arrhythmias). Patients underwent 24 hour Holter monitoring, high-a mplification signal averaged electrocardiography, echocardiography, Thalliu m scintigraphy with a dipyridamole test followed by coronary angiography wh en positive. Patients were aged 60 +/- 8 years, diabetics for 11.8 +/- 6.8 years, and ha d associated cardiovascular risk factors : 85% were obese, 75% were hyperte nsive, 62.5% had hypercholesterolaemia and 60% were smokers. The HbA1C was 9.2 +/- 19%. An increased left ventricular mass was observed in 34.2% of patients. The l eft ventricular ejection fraction was normal (59.1 +/- 6.8%); 69.7% of pati ents had left ventricular diastolic dysfunction. Reduced heart rate variabi lity was observed in 51.8% of cases. Late ventricular potentials were recor ded on high amplification signal averaging in 39.5% of patients; 25.6% had significant ventricular extrasystoles and 52.2% had atrial extrasystoles. T welve patients (45%) underwent Thallium myocardial scintigraphy with a posi tive dipyridamole test, 8 of whom had coronary lesions on angiography. The excess cardiac complications of diabetes is mainly due to ischaemic hea rt disease aggravated by autonomic neuropathy, left ventricular diastolic d ysfunction, arrhythmias and left ventricular hypertrophy. In future, larger series are required to demonstrate that this detection ca n guide therapeutic intervention and reduce cardiac morbidity and mortality of diabetics.