Open AccessImpaired left ventricular diastolic function in T2 DM patients is closely related to glycemic control
Author(s) -
Clarke Geoffrey D.,
MolinaWilkins Marjorie,
SolisHerrera Carolina,
Mendez Verna,
Monroy Adriana,
Cersosimo Eugenio,
Chilton Robert J.,
AbdulGhani Muhammad,
DeFronzo Ralph A.
Publication year - 2018
Publication title -
endocrinology, diabetes and metabolism
Language(s) - English
Resource type - Journals
ISSN - 2398-9238
DOI - 10.1002/edm2.14
Subject(s) - medicine , cardiology , body surface area , isovolumetric contraction , diastole , glycemic , magnetic resonance imaging , insulin , radiology , blood pressure
Summary Background Left ventricular ( LV ) diastolic dysfunction commonly is observed in individuals with type 2 diabetes mellitus (T2 DM ). We employed transthoracic echocardiography ( TTE ) and cardiac magnetic resonance imaging ( CMRI ) to investigate the hypothesis that LV diastolic dysfunction in T2 DM is associated with poor glycemic control. Methods Forty subjects, 21 with normal glucose tolerance ( NGT ) and 19 with T2 DM , were studied with CMRI and TTE to assess LV function. Early‐to‐late transmitral flow ratio (E/A) and deceleration time (DecT) were assessed with both modalities. Normalized (to body surface area) end‐diastolic volume ( EDV / BSA ) and normalized peak LV filling rate ( pLVFR / BSA ) were assessed with CMRI . Early transmitral flow velocity to septal velocity (E/e’) and isovolumetric relaxation time ( IVRT ) were measured using TTE . Dimensional parameters were normalized to body surface area ( BSA ). Results CMRI measurements demonstrated impaired E/A (1.13 ± 0.34 vs 1.62 ± 0.42, P < .001), increased DecT (174 ± 46 ms vs 146 ± 15, P = .005), as well as lower EDV / BSA (63 ± 10 vs 72 ± 9 mL/m 2 , P < .01) and pLVFR / BSA (189 ± 46 vs 221 ± 48 mL s −1 m −2 , P < .05) in T2 DM subjects. TTE measurements revealed lower E/A (1.1 ± 0.4 vs 1.4 ± 0.2, P < .001) and E/e’ (6.8 ± 1.5 vs 8.7 ± 2.0, P < .0001) with higher DecT (203 ± 22 ms vs 179 ± 18, P < .001) and IVRT (106 ± 14 ms vs 92 ± 10, P < .001) in T2 DM . Multiple parameters of LV function: E/ A CMRI ( r = −.50, P = .001), E/ A TTE ( r = −.46, P < .005), pLVFR / BSA ( r = −.35, P < .05), E/e’ ( r = −.46, P < .005), EDV / BSA CMRI ( r = −.51, P < .0001), EDV / BSA TTE ( r = −.42, P < .01) were negatively correlated with HbA1c. All but E/e’ also were inversely correlated with fasting plasma glucose ( FPG ). Conclusions Impaired LV diastolic function ( DF ) was found in T2 DM subjects with both CMRI and TTE , and multiple LVDF parameters correlated negatively with HbA1c and FPG . These results indicate that impaired LVDF is inversely linked to glycemic control in T2 DM patients.