Patients with diabetes mellitus exhibit impaired systolic and diastolic function even in the absence of coronary artery disease (CAD), Danish researchers have shown.

Noting that myocardial dysfunction is a marker of adverse prognosis, they recommend that diabetes patients should be regarded as a high-risk group, even when standard coronary angiography and echocardiography results are normal.

Charlotte Andersson (University of Copenhagen) and co-workers assessed cardiac function in 31 patients with diabetes and 31 healthy controls matched for age, gender, and presence of hypertension. All participants had a left ventricular ejection fraction (LVEF) above 35% and none had significant CAD or other heart disease.

“Patients with diabetes mellitus have high risk of heart failure,” they explain. “Whether some of the risk is directly linked to metabolic derangements in the myocardium or whether the risk is primarily caused by CAD and hypertension is incompletely understood.”

The participants underwent echocardiographic tissue Doppler imaging to assess myocardial function.

Writing in the journal Cardiovascular Diabetology, Andersson et al reveal that mean LVEF, mean left atrial end-systolic volume, mean LV dimensions, and prevalence of diastolic dysfunction were comparable between participants with and without diabetes.

However, diabetes patients had significantly reduced measures of global longitudinal strain (15.9% vs 17.7%), peak longitudinal systolic velocity (5.7 vs 6.4 cm/s) and early diastolic velocity (6.1 vs 7.7 cm/s) compared with controls.

Furthermore, in multivariable regression analyses, diabetes remained associated with impairments in both peak systolic and early diastolic tissue velocities, with mean values in diabetes patients being 89% and 79%, respectively, of those in controls. The presence of hypertension did not modify these findings.

The researchers remark that the Doppler-detected abnormalities observed in diabetes patients were not identifiable from any of the conventional echocardiographic parameters; the findings are therefore “directly applicable to everyday clinical practice.”

“In a clinical context, the subclinical impairments of left ventricular function in patients with diabetes mellitus recognized to carry an adverse prognosis,” they write.

“The results from the present study further emphasize that patients with diabetes mellitus should continuously be regarded as a high-risk group, even when cardiac angiography and conventional echocardiography investigations appear normal.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Free abstract