Impact of left ventricular longitudinal diastolic functional reserve on clinical outcome in patients with type 2 diabetes mellitus

Background Left ventricular longitudinal diastolic functional reserve (DFR), as assessed by the change in early diastolic mitral annular velocity (E′) during exercise, is abnormal in patients with type 2 diabetes mellitus (DM). However, the impact of left ventricular longitudinal DFR on clinical outcome has not been explored. This study evaluated the incremental prognostic value of left ventricular DFR in patients with type 2 DM without overt heart disease. Methods Of 1485 patients who were referred for exercise stress echocardiography, 197 consecutive patients (mean age, 58 years; 84 men) with type 2 DM without overt heart disease were identified. Left ventricular longitudinal DFR was defined as the change in E′ from resting to exercise (ΔE′). The endpoint was a composite of death and hospitalisation for heart failure (HF). Results During a median follow-up of 57 months (range 6–90), 18 of 197 patients (9.1%) had adverse events (12 deaths, six hospitalisations for HF). Independent predictors of adverse events in a Cox regression analysis were estimated glomerular filtration rate (HR 0.97; 95% CI 0.95 to 0.98; p<0.001), DM duration (HR 1.07; 95% CI 1.01 to 1.14; p=0.018) and ΔE′ (HR 0.58; 95% CI 0.40 to 0.85; p=0.005). In an incremental model, the addition of stress echo data significantly increased the χ2 of the clinical and resting left ventricular function model, from 40.5 to 46.6 (p=0.005). Conclusion Assessment of left ventricular longitudinal DFR during exercise provided incremental prognostic information in patients with type 2 DM without overt heart disease.

[1]  M. Kamalesh.  Diabetes and prognosis: are systolic and diastolic heart failure different? , 2008, Heart.

[2]  Michael Böhm,et al.  Kommentar zu den ESC-Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 , 2008, European journal of heart failure.

[3]  J. Oh,et al.  Left ventricular diastolic functional reserve during exercise in patients with impaired myocardial relaxation at rest , 2007, Heart.

[4]  E. Abel,et al.  Diabetic cardiomyopathy revisited. , 2007, Circulation.

[5]  G. de Simone,et al.  Impaired inotropic response in type 2 diabetes mellitus: a strain rate imaging study. , 2007, American journal of hypertension.

[6]  S. White,et al.  Disturbed hemodynamic cardiac exercise stress test response in non-smoking, normolipidemic, normotensive, diabetic subjects. , 2007, Diabetes research and clinical practice.

[7]  S. Jones,et al.  All‐cause and cardiovascular mortality in diabetic subjects increases significantly with reduced estimated glomerular filtration rate (eGFR): 10 years’ data from the South Tees Diabetes Mortality study , 2007, Diabetic medicine : a journal of the British Diabetic Association.

[8]  J. Oh,et al.  Abnormal left ventricular longitudinal functional reserve in patients with diabetes mellitus: implication for detecting subclinical myocardial dysfunction using exercise tissue Doppler echocardiography , 2006, Heart.

[9]  L. Brodin,et al.  Impaired myocardial functional reserve in hypertension and diabetes mellitus without coronary artery disease: Searching for the possible link with congestive heart failure in the myocardial Doppler in diabetes (MYDID) study II. , 2006, American journal of hypertension.

[10]  A. Hoes,et al.  Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. , 2005, European heart journal.

[11]  T. Marwick,et al.  Screening for heart disease in diabetic subjects. , 2005, American heart journal.

[12]  T. Marwick,et al.  Determinants of subclinical diabetic heart disease , 2005, Diabetologia.

[13]  T. Marwick.  Tissue Doppler imaging for evaluation of myocardial function in patients with diabetes mellitus , 2004, Current opinion in cardiology.

[14]  Thomas H Marwick,et al.  Diabetic cardiomyopathy: evidence, mechanisms, and therapeutic implications. , 2004, Endocrine reviews.

[15]  S. Wild,et al.  Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. , 2004, Diabetes care.

[16]  Julio E. Pérez,et al.  Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. , 2004, The American journal of cardiology.

[17]  A. Fraser,et al.  Subclinical left ventricular dysfunction in asymptomatic patients with Type II diabetes mellitus, related to serum lipids and glycated haemoglobin. , 2003, Clinical science.

[18]  L. Bouter,et al.  Impact of diabetes duration and cardiovascular risk factors on mortality in type 2 diabetes: the Hoorn Study , 2002, European journal of clinical investigation.

[19]  P. Savage,et al.  Diabetes mellitus: subclinical cardiovascular disease and risk of incident cardiovascular disease and all-cause mortality. , 2000, Arteriosclerosis, thrombosis, and vascular biology.

[20]  K. Ohmori,et al.  Alteration in left ventricular diastolic filling and accumulation of myocardial collagen at insulin-resistant prediabetic stage of a type II diabetic rat model. , 2000, Circulation.

[21]  Yangyu,et al.  Alteration in Left Ventricular Diastolic Filling and Accumulation of Myocardial Collagen at Insulin-Resistant Prediabetic Stage of a Type II Diabetic Rat Model , 2000 .

[22]  C. Fortin,et al.  Impact of left ventricular diastolic dysfunction on maximal treadmill performance in normotensive subjects with well-controlled type 2 diabetes mellitus. , 2000, The American journal of cardiology.

[23]  J. Melin,et al.  Contribution of left ventricular diastolic function to exercise capacity in normal subjects. , 1993, Journal of applied physiology.

[24]  J. Zatuchni.  Atrial enlargement as a consequence of atrial fibrillation. , 1991, Circulation.

[25]  A. Weyman,et al.  Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. , 1990, Circulation.

[26]  R L Popp,et al.  Relation of Transmitral Flow Velocity Patterns to Left Ventricle Diastolic Function: New Insights From a Combined Hemodynamic and Doppler Echocardiographic Study , 1988, Journal of the American College of Cardiology.

[27]  A. Vinik,et al.  Decreased Exercise Heart Rate and Blood Pressure Response in Diabetic Subjects With Cardiac Autonomic Neuropathy , 1986, Diabetes Care.

[28]  N. Reichek,et al.  Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. , 1986, The American journal of cardiology.

[29]  S. Nunoda,et al.  Quantitative approach to the histopathology of the biopsied right ventricular myocardium in patients with diabetes mellitus , 1985, Heart and Vessels.

[30]  J. Laragh,et al.  Standardization of M-mode echocardiographic left ventricular anatomic measurements. , 1984, Journal of the American College of Cardiology.

[31]  A E Becker,et al.  Left ventricular fibre architecture in man. , 1981, British heart journal.

[32]  C L Feldman,et al.  Assessment of Left Ventricular Ejection Fraction and Volumes by Real-time, Two-dimensional Echocardiography: A Comparison of Cineangiographic and Radionuclide Techniques , 1979, Circulation.

[33]  J. Seward,et al.  Effects of treadmill exercise on mitral inflow and annular velocities in healthy adults. , 2003, The American journal of cardiology.

[34]  D. Khoury,et al.  Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. , 2001, Journal of the American College of Cardiology.

[35]  W. Abelmann,et al.  Assessment of Left Ventricular Ejection Fraction and Volumes by Real-time , Two-dimensional Echocardiography A Comparison of Cineangiographic and Radionuclide Techniques , 2022 .