Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes - Importance of maneuvers in echocardiographic screening for preclinical diabetic cardiomyopathy

OBJECTIVE - Because a pseudonormal pattern of ventricular filling has never been considered in studies that reported a prevalence of left ventricular diastolic dysfunction (LVDD) between 20 and 40%, our aim was to more comple tely evaluate the prevalence of LVDD in subjects with diabetes. RESEARCH DESIGN AND METHODS - We studied 46 men with type 2 diabetes who we re aged 38-67 years; without evidence of diabetic complications, hypertensi on, coronary artery disease, congestive heart failure, or thyroid or overt renal disease; and with a maximal treadmill exercise test showing no ischem ia. LVDD was evaluated by Doppler echocardiography, which included the use of the Valsalva maneuver and pulmonary Venous recordings to unmask a pseudo normal pattern of left ventricular filling. RESULTS - LVDD was found in 28 subjects (60%), of whom 13 (28%) had a pseud onormal pattern of ventricular filling and 15 (32%) had impaired relaxation . Systolic function was normal in all subjects, and there was no correlatio n between LVDD and indexes of metabolic control. CONCLUSIONS - LVDD is much more common than previously reported in subjects with well-controlled type 2 diabetes who are free of clinically detectable heart disease. The high prevalence of this phenomenon in this high-risk po pulation suggests that screening for LVDD in type 2 diabetes should include procedures such as the Valsalva maneuver and pulmonary venous recordings t o unmask a pseudonormal pattern of ventricular filling.