Tissue Doppler Imaging Identifies Asymptomatic Normotensive Diabetics with Diastolic Dysfunction and Reduced Exercise Tolerance

Background: Early recognition of heart disease in diabetics is a highly desirable goal, and diastolic dysfunction, one of its earliest manifestations, can be readily assessed by tissue Doppler imaging. We tested in normotensive diabetics without signs of coronary artery disease whether tissue Dopple...

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Published in:	Echocardiography (Mount Kisco, N.Y.) Vol. 22; no. 7; pp. 561 - 570
Main Authors:	Saraiva, Roberto M., Duarte, Dario M., Duarte, Monica P.C., Martins, Adriana F., Poltronieri, Alexandre V.G., Ferreira, Maria E., Silva, Marcia C., Hohleuwerger, Rosangela, Ellis, Alberto, Rachid, Mauricio B., Monteiro, Carla F.C., Kaiser, Sérgio E.
Format:	Journal Article
Language:	English
Published:	350 Main St , Malden , MA 02148 , USA , and PO Box 1354, Garsington Rd , Oxford OX4 2DQ , UK and PO Box 378 Carlton South , 3053 Victoria , Australia Blackwell Science Inc 01-08-2005
Subjects:	Adult Blood Pressure Diabetes Complications diabetes mellitus Diabetes Mellitus - physiopathology Diastole diastolic dysfunction echocardiography Echocardiography, Doppler Exercise Tolerance Female Humans Male Middle Aged tissue Doppler imaging Ventricular Dysfunction, Left - complications Ventricular Dysfunction, Left - diagnostic imaging
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Summary:	Background: Early recognition of heart disease in diabetics is a highly desirable goal, and diastolic dysfunction, one of its earliest manifestations, can be readily assessed by tissue Doppler imaging. We tested in normotensive diabetics without signs of coronary artery disease whether tissue Doppler imaging would improve the diagnosis of diastolic dysfunction beyond classical criteria and identify patients already presenting impaired cardiac performance. Methods: We studied 79 patients (56 males, 55 type‐2 diabetes mellitus) who underwent Doppler echocardiography, and exercise testing. Diastolic dysfunction was diagnosed either based on European Study Group on Diastolic Heart Failure guidelines or by tissue Doppler imaging provided that both of the following criteria were met: Em/Am ratio <1; and Em < 8.5 cm/sec. Results: Tissue Doppler imaging identified diastolic dysfunction in 26.6% of diabetics, while classical criteria did so in 40.5% of the cases. The group identified by classical criteria did not differ significantly from patients without diastolic dysfunction, while in the group identified by Tissue Doppler imaging, significant differences were highlighted, including worse exercise tolerance and higher left ventricular mass index. Moreover, in multiple regression analysis, Em myocardial velocity and body mass index were the only variables independently related to exercise tolerance. Conclusion: Differently from classical criteria based on pulsed Doppler, Tissue Doppler imaging identifies a group of asymptomatic normotensive diabetics with diastolic dysfunction and reduced exercise tolerance. Confirmation of the prognostic importance of our findings could justify the use of Tissue Doppler imaging for diastolic function assessment in diabetics with otherwise healthy hearts.
Bibliography:	istex:410A25620980947E9C5867988BD2893E1CA2D2DF ark:/67375/WNG-DKM4S7S9-T ArticleID:ECHO40051 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0742-2822 1540-8175
DOI:	10.1111/j.1540-8175.2005.40051.x