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Figure 1 The hypothetical link of metabolic alterations to left ventricular (LV) function and coronary microcirculation in diabetes mellitus. Hyperglycemia, insulin resistance, sympathetic overdrive, endothelial dysfunction, abnormalities of the angiotensin-renin system (ARS), and LV remodeling/hypertrophy may induce diastolic dysfunction (DD) and impairment of the coronary microcirculation. The microvascular alterations may induce DD or vice versa. The LV systolic involvement appears subsequent to DD and/or coronary microvascular dysfunction. Ultrasound technology may detect DD and increased LV filling pressure (Doppler mitral inflow + mitral annular tissue Doppler) and impairment of coronary microcirculation (CFR) and of midwall systolic function. CFR = coronary flow reserve; MFS = midwall fractional shortening; TTE = transthoracic echocardiography.
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