Abnormal myocardial acoustic properties in diabetic patients and their correlation with the severity of disease

Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri 63110.

Although patients with diabetes mellitus may be afflicted by cardiomyopathy, its prevalence and nature are controversial. Studies have shown that fibrosis alters the acoustic properties of the heart in animals and humans and that the changes are detectable by cardiac tissue characterization with ultrasound. The present study was performed to characterize myocardial acoustic properties in patients with insulin-dependent diabetes to determine whether ultrasound tissue characterization could detect changes potentially indicative of occult cardiomyopathy. The magnitude of cyclic variation of myocardial ultrasound integrated backscatter and its phase delay with respect to the onset of the cardiac cycle in the septum and posterior wall of the left ventricle were measured in 54 patients with diabetes who had no overt cardiac disease. Conventional echocardiography documented normal ventricular systolic function in 96%. As compared with results in age-matched patients without diabetes studied previously, cyclic variation of integrated backscatter was reduced (4.6 +/- 0.8 vs. 3.6 +/- 1.4 dB; p less than 0.001). In addition, delay was significantly increased (0.86 +/- 0.09 vs. 0.99 +/- 0.15). The primary analysis of the data focused on differences among the diabetic patients. Reduction of cyclic variation of backscatter was greatest in patients with diabetes who had neuropathy (3.2 +/- 1.0 dB; p less than 0.001) as was the increase in delay (1.04 +/- 0.16, p less than 0.001 vs. values in patients without neuropathy). Retinopathy and nephropathy were associated with abnormal myocardial acoustic properties as well. Thus, abnormalities that may reflect fibrosis or other occult cardiomyopathic changes in diabetic patients without overt heart disease are readily detectable by myocardial tissue characterization with ultrasound and parallel the severity of noncardiac diabetic complications.

This article has been cited by other articles:

				T. Ohno, S. Takamoto, and N. Motomura Diabetic Retinopathy and Coronary Artery Disease From the Cardiac Surgeon's Perspective Ann. Thorac. Surg., February 1, 2008; 85(2): 681 - 689. [Abstract] [Full Text] [PDF]

				E. Agabiti-Rosei, M. L. Muiesan, and M. Salvetti Review: New approaches to the assessment of left ventricular hypertrophy Therapeutic Advances in Cardiovascular Disease, December 1, 2007; 1(2): 119 - 128. [Abstract] [PDF]

				A. Loimaala, K. Groundstroem, S. Majahalme, A. Nenonen, and I. Vuori Impaired myocardial function in newly onset Type 2 diabetes associates with arterial stiffness Eur J Echocardiogr, October 1, 2006; 7(5): 341 - 347. [Abstract] [Full Text] [PDF]

				S. Sulfi and A. D Timmis Review: Heart failure complicating acute myocardial infarction in patients with diabetes: pathophysiology and management strategies The British Journal of Diabetes & Vascular Disease, September 1, 2006; 6(5): 191 - 196. [Abstract] [PDF]

				E Hyodo, T Hozumi, Y Takemoto, H Watanabe, T Muro, H Yamagishi, M Yoshiyama, K Takeuchi, and J Yoshikawa Early detection of cardiac involvement in patients with sarcoidosis by a non-invasive method with ultrasonic tissue characterisation Heart, November 1, 2004; 90(11): 1275 - 1280. [Abstract] [Full Text] [PDF]

				I. Thrainsdottir, K. Malmberg, A. Olsson, M. Gutniak, and L. Ryden Initial experience with GLP-1 treatment on metabolic control and myocardial function in patients with type 2 diabetes mellitus and heart failure Diabetes and Vascular Disease Research, May 1, 2004; 1(1): 40 - 43. [Abstract] [PDF]

				E. Picano Diabetic cardiomyopathy: the importance of being earliest J. Am. Coll. Cardiol., August 6, 2003; 42(3): 454 - 457. [Full Text] [PDF]

				Z. Y. Fang, S. Yuda, V. Anderson, L. Short, C. Case, and T. H. Marwick Echocardiographic detection of early diabetic myocardial disease J. Am. Coll. Cardiol., February 19, 2003; 41(4): 611 - 617. [Abstract] [Full Text] [PDF]

				M. Kozakova, S. Buralli, C. Palombo, G. Bernini, A. Moretti, S. Favilla, S. Taddei, and A. Salvetti Myocardial Ultrasonic Backscatter in Hypertension: Relation to Aldosterone and Endothelin Hypertension, February 1, 2003; 41(2): 230 - 236. [Abstract] [Full Text] [PDF]

				S. D. Solomon, M. S. J. Sutton, G. A. Lamas, T. Plappert, J. L. Rouleau, H. Skali, L. Moye, E. Braunwald, M. A. Pfeffer, and for the Survival And Ventricular Enlargement (SAVE Ventricular Remodeling Does Not Accompany the Development of Heart Failure in Diabetic Patients After Myocardial Infarction Circulation, September 3, 2002; 106(10): 1251 - 1255. [Abstract] [Full Text] [PDF]

				J. Koyama, P. A. Ray-Sequin, and R. H. Falk Prognostic Significance of Ultrasound Myocardial Tissue Characterization in Patients With Cardiac Amyloidosis Circulation, July 30, 2002; 106(5): 556 - 561. [Abstract] [Full Text] [PDF]

				H. Taegtmeyer, P. McNulty, and M. E. Young Adaptation and Maladaptation of the Heart in Diabetes: Part I: General Concepts Circulation, April 9, 2002; 105(14): 1727 - 1733. [Full Text] [PDF]

				T Muro, T Ota, H Watanabe, M Teragaki, K Takeuchi, and J Yoshikawa Prediction of contractile reserve by cyclic variation of integrated backscatter of the myocardium in patients with chronic left ventricular dysfunction Heart, February 1, 2001; 85(2): 165 - 170. [Abstract] [Full Text]

				K. Mizushige, L. Yao, T. Noma, H. Kiyomoto, Y. Yu, N. Hosomi, K. Ohmori, and H. Matsuo Alteration in Left Ventricular Diastolic Filling and Accumulation of Myocardial Collagen at Insulin-Resistant Prediabetic Stage of a Type II Diabetic Rat Model Circulation, February 29, 2000; 101(8): 899 - 907. [Abstract] [Full Text] [PDF]

				A. M. Pellicelli, J. Barba Cosial, E. Ferranti, A. Gomez, and M. C. Borgia Alteration of Left Ventricular Filling Evaluated by Doppler Echocardiography as a Potential Marker of Acute Rejection in Orthotopic Heart Transplant Angiology, January 1, 1996; 47(1): 35 - 41. [Abstract] [PDF]

				S. Nozaki, A. N. DeMaria, G. A. Helmer, and H. K. Hammond Detection of Regional Left Ventricular Dysfunction in Early Pacing-Induced Heart Failure Using Ultrasonic Integrated Backscatter Circulation, November 1, 1995; 92(9): 2676 - 2682. [Abstract] [Full Text]

				V. Salomaa, W. Riley, J. D. Kark, C. Nardo, and A. R. Folsom Non–Insulin-Dependent Diabetes Mellitus and Fasting Glucose and Insulin Concentrations Are Associated With Arterial Stiffness Indexes : The ARIC Study Circulation, March 1, 1995; 91(5): 1432 - 1443. [Abstract] [Full Text]

				A. D. Waggoner, B. Barzilai, J. G. Miller, and J. E. Perez Quantitative Echocardiography, Part 1: Myocardial Tissue Characterization with Analysis of Radiofrequency Signas Journal of Diagnostic Medical Sonography, May 1, 1993; 9(3): 122 - 134. [Abstract] [PDF]