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Relationship between myocardial perfusion and dysfunction in diabetic cardiomyopathy: a study of quantitative contrast echocardiography and strain rate imaging
  1. S Moir,
  2. L Hanekom,
  3. Z-Y Fang,
  4. B Haluska,
  5. C Wong,
  6. M Burgess,
  7. T H Marwick
  1. University of Queensland, Brisbane, Australia
  1. Correspondence to:
    Professor Thomas H Marwick
    University of Queensland Department of Medicine, Princess Alexandra Hospital, Ipswich Road, Brisbane, Q4102, Australia; tmarwick{at}


Objective: To use quantitative myocardial contrast echocardiography (MCE) and strain rate imaging (SRI) to assess the role of microvascular disease in subclinical diabetic cardiomyopathy.

Methods: Stress MCE and SRI were performed in 48 patients (22 with type II diabetes mellitus (DM) and 26 controls), all with normal left ventricular systolic function and no obstructive coronary disease by quantitative coronary angiography. Real-time MCE was acquired in three apical views at rest and after combined dipyridamole–exercise stress. Myocardial blood flow (MBF) was quantified in the 10 mid- and apical cardiac segments at rest and after stress. Resting peak systolic strain rate (SR) and peak systolic strain (ε) were calculated in the same 10 myocardial segments.

Results: The DM and control groups were matched for age, sex and other risk factors, including hypertension. The DM group had higher body mass index and left ventricular mass index. Quantitative SRI analysis was possible in all patients and quantitative MCE in 46 (96%). The mean ε, SR and MBF reserve were all significantly lower in the DM group than in controls, with diabetes the only independent predictor of each parameter. No correlation was seen between MBF and SR (r  =  −0.01, p  =  0.54) or between MBF and ε (r  =  −0.20, p  =  0.20).

Conclusions: Quantitative MCE shows that patients with diabetes but no evidence of obstructive coronary artery disease have impaired MBF reserve, but abnormal transmural flow and subclinical longitudinal myocardial dysfunction are not related.

  • A, peak late diastolic velocity
  • ACE, angiotensin-converting enzyme
  • CAD, coronary artery disease
  • DM, diabetes mellitus
  • ε, peak systolic strain
  • E, peak early diastolic velocity
  • E′, early peak myocardial diastolic velocity
  • LV, left ventricular
  • MBF, myocardial blood flow
  • MCE, myocardial contrast echocardiography
  • S′, peak myocardial systolic velocity
  • SR, strain rate
  • SRI, strain rate imaging
  • cardiomyopathy
  • diabetes mellitus
  • myocardial contrast echocardiography
  • strain rate imaging

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  • Published Online First 10 April 2006

  • Supported in part by a Centres of Clinical Research Excellence award from the National Health and Medical Research Council, Canberra, Australia