CLINICAL STUDY
Patients with early diabetic heart disease demonstrate a normal myocardial response to dobutamine
Zhi You Fang, BM, MHSc*,
Ofelia Najos-Valencia, MD*,
Rodel Leano, BSc* and
Thomas H. Marwick, MB, BS, PhD, FACC*,*
* University of Queensland, Brisbane, Australia
Manuscript received September 5, 2002;
revised manuscript received January 12, 2003,
accepted January 16, 2003.
* Reprint requests and correspondence: Prof. Thomas H. Marwick, University of Queensland Department of Medicine, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4012, Australia.
tmarwick{at}medicine.pa.uq.edu.au
OBJECTIVES: We sought to use quantitative markers of the regional left ventricular (LV) response to stress to infer whether diabetic cardiomyopathy is associated with ischemia.
BACKGROUND: Diabetic cardiomyopathy has been identified in clinical and experimental studies, but its cause remains unclear.
METHODS: We studied 41 diabetic patients with normal resting LV function and a normal dobutamine echo and 41 control subjects with a low probability of coronary disease. Peak myocardial systolic velocity (Sm) and early diastolic velocity (Em) in each segment were averaged, and mean Sm and Em were compared between diabetic patients and controls and among different stages of dobutamine stress.
RESULTS: Both Sm and Em progressively increased from rest to peak dobutamine stress. In the diabetic group, Sm was significantly lower than in control subjects at baseline (4.2 ± 0.9 cm/s vs. 4.7 ± 0.9 cm/s, p = 0.012). However, Sm at a low dose (6.0 ± 1.3), before peak (8.4 ± 1.8), and at peak stress (8.9 ± 1.8) in diabetic patients was not significantly different from that of controls (6.3 ± 1.4, 8.9 ± 1.6, and 9.6 ± 2.1 cm/s, respectively). The Em (cm/s) in the diabetic group (rest: 4.2 ± 1.2; low dose: 5.0 ± 1.4; pre-peak: 5.3 ± 1.1; peak: 5.9 ± 1.5) was significantly lower than that of controls (rest: 5.8 ± 1.5; low dose: 6.6 ± 1.5; pre-peak: 6.9 ± 1.3; peak: 7.3 ± 1.7; all p < 0.001). However, the absolute and relative increases in Sm or Em from rest to peak stress were similar in diabetic and control groups.
CONCLUSIONS: Subtle LV dysfunction is present in diabetic patients without overt cardiac disease. The normal response to stress suggests that ischemia due to small-vessel disease may not be important in early diabetic heart muscle disease.
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Abbreviations and Acronyms
| | A | | mitral peak late diastolic velocity | | BP | | blood pressure | | CAD | | coronary artery disease | | DbE | | dobutamine stress echocardiogram/echocardiography | | E | | mitral peak early diastolic velocity | | Em | | myocardial peak early diastolic velocity | | HR | | heart rate | | LV | | left ventricle/ventricular | | Sm | | myocardial peak systolic velocity | | TDI | | tissue Doppler imaging |
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