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Abnormal left ventricular longitudinal functional reserve in patients with diabetes mellitus: Implication for detecting subclinical myocardial dysfunction using exercise tissue Doppler echocardiography
  1. Jong-Won Ha (jwha{at}yumc.yonsei.ac.kr)
  1. Yonsei University College of Medicine, Korea, Republic of
    1. Hyun-Chul Lee
    1. Yonsei University College of Medicine, Korea, Republic of
      1. Eun-Seok Kang
      1. Yonsei University College of Medicine, Korea, Republic of
        1. Chul-Min Ahn
        1. Yonsei University College of Medicine, Korea, Republic of
          1. Jin-Mi Kim
          1. Yonsei University College of Medicine, Korea, Republic of
            1. Jeong-Ah Ahn
            1. Yonsei University College of Medicine, Korea, Republic of
              1. Se-Wha Lee
              1. Yonsei University College of Medicine, Korea, Republic of
                1. Eui-Young Choi
                1. Yonsei University College of Medicine, Korea, Republic of
                  1. Se-Joong Rim
                  1. Yonsei University College of Medicine, Korea, Republic of
                    1. Jae K Oh
                    1. Mayo Clinic, United States
                      1. Namsik Chung
                      1. Yonsei University College of Medicine, Korea, Republic of

                        Abstract

                        Sublinical myocardial dysfunction occurs in a significant number of patients with type 2 diabetes. Assessment of ventricular long-axis function by measuring mitral annular velocities using tissue Doppler echocardiography (TDE) is thought to provide a more sensitive index of systolic and diastolic function. We hypothesized that augmentation of left ventricular (LV) longitudinal contraction and relaxation during exercise would be blunted in patients with type 2 diabetes. Mitral annular systolic (S') and early diastolic (E') velocities were measured at rest and during supine bicycle exercise (25W, 3 minutes increments) in 53 patients (27 male, mean age 53±14 years) with type 2 diabetes and 53 subjects with age and gender-matched control. None had echocardiographic evidence of resting or inducible myocardial ischemia. <BR> There were no significant differences in mitral inflow velocities at rest between the two groups. E' and S' at rest were also similar between the groups. However, S' (7.1±1.3 vs 8.3±1.8 cm/s at 25 W, p=0.0021; 8.1±1.5 vs 9.1±2.0 cm/s at 50 W, p=0.026) and E' (8.5±2.3 vs 9.9±3.1 cm/s at 25 W, p=0.054; 9.1±2.1 vs 10.9±2.5 cm/s at 50 W, p=0.0093) during exercise was significantly lower in patients with diabetes compared with controls. Longitudinal systolic and diastolic function reserve indices were significantly lower in patients with diabetes compared with that of controls (systolic index, 0.6±0.70 vs 1.2±1.5 cm/s at 25 Watts, p=0.029; 1.2±1.2 vs 2.1±1.6 cm/s at 50 Watts, p=0.009; diastolic index, 1.9±1.2 vs 2.5±2.2 cm/s at 25 Watts, p=0.07; 2.3±1.3 vs 3.2±2.2 cm/s at 50 Watts, p=0.031). <BR> In conclusion, unlike resting mitral inflow and annular velocities, changes of systolic and diastolic velocities of the mitral annulus during exercise were significantly reduced in patients with type 2 diabetes compared to the control group. The assessment of LV longitudinal functional reserve with exercise using TDE appears to be helpful in identifying early myocardial dysfunction in patients with type 2 diabetes.

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