Yi Liu1, Jing Ma2, Jia Guo1, Hao Lu3, Yan Zhang1, Yilei Chen3. 1. Department of Ultrasonography, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China. 2. Division of Cardiology, Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, People's Republic of China. 3. Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.
Abstract
BACKGROUND: Diabetic cardiomyopathy (DCM) will gradually progress to heart failure without intervention. The timely identification of left ventricular diastolic dysfunction (LVDD) in the early stage and active intervention helps delay the onset of heart failure. Although myocardial contrast echocardiography (MCE) allows an accurate evaluation of myocardial perfusion (MP), the characteristics of MP in early-stage or even sub-clinical LVDD are still unclear. OBJECTIVE: This study aims to reveal the characteristics of MP in asymptomatic and normotensive patients with type 2 diabetes mellitus (T2DM) using MCE and investigate its association with LVDD development. METHODS: A total of 327 T2DM patients were retrospectively analyzed. Patients diagnosed with LVDD were included in the LVDD+ group (n = 76), and those with normal left ventricular diastolic function were included in the LVDD- group (n = 251). The clinical characteristics, general echocardiographic findings, and MCE parameters were compared between the two groups. The accuracy of MCE parameters in the diagnosis of LVDD and their correlations with characteristics of T2DM were evaluated. RESULTS: In the LVDD+ group, the A×β (derived from the replenishment curve of MCE, presenting myocardial blood flow) was significantly lower, and the HbA1c and diabetes duration were significantly higher compared to the LVDD- group (all P < 0.05). The decrease of A×β helped warn the occurrence of LVDD although it was not suitable for the independent diagnosis of LVDD (AUC = 0.745). A×β was negatively correlated with diabetes duration and HbA1c (r = -0.350 and -0.226, both P < 0.001). CONCLUSION: MCE was feasible for detecting MP abnormalities in asymptomatic T2DM patients. Although the A×β values of T2DM patients with subclinical LVDD were better than those with diagnosed LVDD, it impaired with the increase of HbA1c and diabetes duration. It suggested that MCE might be useful for monitoring glycemic control in T2DM patients with DCM.
BACKGROUND: Diabetic cardiomyopathy (DCM) will gradually progress to heart failure without intervention. The timely identification of left ventricular diastolic dysfunction (LVDD) in the early stage and active intervention helps delay the onset of heart failure. Although myocardial contrast echocardiography (MCE) allows an accurate evaluation of myocardial perfusion (MP), the characteristics of MP in early-stage or even sub-clinical LVDD are still unclear. OBJECTIVE: This study aims to reveal the characteristics of MP in asymptomatic and normotensive patients with type 2 diabetes mellitus (T2DM) using MCE and investigate its association with LVDD development. METHODS: A total of 327 T2DM patients were retrospectively analyzed. Patients diagnosed with LVDD were included in the LVDD+ group (n = 76), and those with normal left ventricular diastolic function were included in the LVDD- group (n = 251). The clinical characteristics, general echocardiographic findings, and MCE parameters were compared between the two groups. The accuracy of MCE parameters in the diagnosis of LVDD and their correlations with characteristics of T2DM were evaluated. RESULTS: In the LVDD+ group, the A×β (derived from the replenishment curve of MCE, presenting myocardial blood flow) was significantly lower, and the HbA1c and diabetes duration were significantly higher compared to the LVDD- group (all P < 0.05). The decrease of A×β helped warn the occurrence of LVDD although it was not suitable for the independent diagnosis of LVDD (AUC = 0.745). A×β was negatively correlated with diabetes duration and HbA1c (r = -0.350 and -0.226, both P < 0.001). CONCLUSION: MCE was feasible for detecting MP abnormalities in asymptomatic T2DM patients. Although the A×β values of T2DM patients with subclinical LVDD were better than those with diagnosed LVDD, it impaired with the increase of HbA1c and diabetes duration. It suggested that MCE might be useful for monitoring glycemic control in T2DM patients with DCM.
Authors: Alain G Bertoni; W Gregory Hundley; Mark W Massing; Denise E Bonds; Gregory L Burke; David C Goff Journal: Diabetes Care Date: 2004-03 Impact factor: 19.112
Authors: Richard M Cubbon; Brook Adams; Adil Rajwani; Ben N Mercer; Peysh A Patel; Guy Gherardi; Christopher P Gale; Phillip D Batin; Ramzi Ajjan; Lorraine Kearney; Stephen B Wheatcroft; Robert J Sapsford; Klaus K Witte; Mark T Kearney Journal: Diab Vasc Dis Res Date: 2013-01-24 Impact factor: 3.291