ORIGINAL ARTICLES   

Panminerva Medica 1998 September;40(3):204-9

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Left ventricular filling in young patients affected by insulin-dependent diabetes mellitus: a stress Doppler echocardiographic study

Borgia M. C., Pellicelli A. M., Medici F., Barba Cosial J.*, Cabañero J.*, Huelmos A.*, De Paola G., Lionetti M.

From the Institute of Medicine University of Rome “La Sapienza”, Rome, Italy and the * Department of Cardiology and Cardiovascular Surgery University of Navarra, Pamplona, Spain

Background. The pur­pose of ­this ­study was to ana­lyze dia­stol­ic func­tion in two dif­fer­ent pop­u­la­tions of ­young ­patients affect­ed by insu­lin­ de­pen­dent dia­betes mel­lit­us (­IDDM), ­with and with­out system­ic dia­bet­ic com­pli­ca­tions, and to com­pare the ­results ­obtained at ­rest ­with ­those ­obtained dur­ing iso­met­ric exer­cise.
Methods. Forty-­five ­IDDM dia­bet­ic ­patients ­were stud­ied. On the ­basis of pres­ence or ­absence of system­ic dia­bet­ic com­pli­ca­tions (neph­rop­a­thy and reti­nop­a­thy) ­patients ­were divid­ed ­into two ­groups. Group I (20 ­patients) with­out and Group II (25 ­patients) ­with dia­bet­ic com­pli­ca­tions. Diastolic func­tion param­e­ters ­were meas­ured by Doppler ech­o­car­di­og­ra­phy at ­rest and dur­ing iso­met­ric exer­cise. The two ­groups ­were sim­i­lar regard­ing age, meta­bol­ic con­trol and insu­lin dos­age but ­there ­were sig­nif­i­cant dif­fer­enc­es in dia­stol­ic and sys­tol­ic ­blood pres­sure and ­heart ­rate ­between the two ­groups, the ­patients ­with com­pli­ca­tions show­ing high­er val­ues (p<0.001, p<0.005, p<0.01 respec­tive­ly).
Results. Group II ­already pre­sent­ed at ­rest alter­a­tions of dia­stol­ic func­tion param­e­ters ­respect to Group I ­with a ­marked ­increase of: ­peak veloc­ity of ­late ­left ven­tric­u­lar fill­ing (peakA cm/sec), (60.1±13.4 ver­sus 48.4±8.9, p<0.01); ­late ­left ven­tric­u­lar fill­ing inte­gral (A ­area), (6.5±1.4 ver­sus 5.0±0.8, p<0.05); ­late ­left ven­tric­u­lar fill­ing inte­gral ­over ­total fill­ing (A ­area/­total ­area), (0.31±0.06 ver­sus 0.26±0.06, p<0.01). There was a ­decrease of E/A ­ratio in Group II ver­sus Group I (1.5±0.32 ver­sus 1.9±0.5, p<0.05). During iso­met­ric exer­cise ­these chang­es ­became ­even ­more pro­nounced in ­patients ­with com­pli­ca­tions and in ­this ­group ­there was a ­marked ­decrease of ­flow inte­gral of ear­ly ­left ven­tric­u­lar fill­ing ­over ­total fill­ing (E ­area/­total ­area), (0.57±0.09 ver­sus 0.68±0.07, p<0.01).
Conclusions. In con­clu­sion, ­young ­IDDM ­patients ­with com­pli­ca­tions ­show an impair­ment of dia­stol­ic func­tion ­more pro­nounced ­than ­those with­out. These chang­es are ­more evi­dent dur­ing iso­met­ric exer­cise. Stress Doppler ech­o­car­di­og­ra­phy is a reli­able ­tool to ­detect ear­ly dia­stol­ic dys­func­tion in diab­et­ic ­patients.