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Paradoxical Increase in Ventricular Torsion and Systolic Torsion Rate in Type I Diabetic Patients Under Tight Glycemic Control

Jina Chung, MD^_*, Paul Abraszewski, MD^_*, Xin Yu, ScD, Wei Liu, ScD, Andrew J. Krainik, MD, MPH, Marvin Ashford, MD^_*, Shelton D. Caruthers, PhD^,,, Janet B. McGill, MD and Samuel A. Wickline, MD, FACC^_*,,_*

^_* Cardiovascular Magnetic Resonance Laboratories
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine
Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, Missouri
Philips Medical Systems, Best, the Netherlands

View larger version (9K): [in a new window]   Figure 1 Torsion during cardiac cycle. *Significant torsion differences between diabetics and control 1 patients during systole, isovolumic relaxation, and early diastole (p < 0.05). At end systole (100% ES), diabetics had a 23% increase in torsion compared with the control 1 patients. %ES = percent systolic duration. Solid squares = control 1 patients (n = 10); open squares = diabetics (n = 16).

View larger version (16K): [in a new window]   Figure 2 Global and segmental torsion. Global torsion was significantly higher in diabetics (p = 0.01). However, segmental torsion differences were not statistically significant. Solid bars = control 1 patients (n = 10); open bars = diabetics (n = 16).

View larger version (11K): [in a new window]   Figure 3 Torsion rate during cardiac cycle. *Significant torsion rate differences between diabetics and control 1 patients during early systole (p < 0.05). #There was a trend toward a higher maximal torsion rate during recoil (TR-r) in diabetics (p = 0.07). %ES = percent systolic duration. Solid squares = control 1 patients (n = 10); open squares = diabetics (n = 16).

View larger version (13K): [in a new window]   Figure 4 Correlation between hemoglobin A1c (HbA1c) and maximal torsion rate during systole (TR-s). Circles = diabetics; line = line fit.

View larger version (18K): [in a new window]   Figure 5 Chronotropic and inotropic effects on torsion. Chronotropic stimulation with atropine did not alter torsion significantly from the baseline despite a significant heart rate elevation (p = NS). Torsion after inotropic stimulation with exercise was significantly higher than at baseline (p = 0.004) or post-atropine (p = 0.01).