VIEWPOINT
Diastolic Dysfunction and Diabetic Cardiomyopathy
Evaluation by Doppler Echocardiography
Maurizio Galderisi, MD*
Echocardiography Laboratory, Division of Cardioangiology, Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy
Manuscript received September 27, 2005;
revised manuscript received May 30, 2006,
accepted June 22, 2006.
* Reprint requests and correspondence: Dr. Maurizio Galderisi, Echocardiography Laboratory, Division of Cardioangiology, Department of Clinical and Experimental Medicine, Federico II University Hospital, Via S. Pansini 5, 80131 Naples, Italy (Email: mgalderi{at}unina.it).
Doppler echocardiography has largely contributed to show the existence of a distinct diabetic cardiomyopathy. Several studies have pointed out the evidence of left ventricular (LV) remodeling and hypertrophy in alterations of both midwall systolic mechanics and LV diastolic filling in diabetes mellitus (DM), independent of the coexistence of concomitant risk factors. Further progress will be provided by new ultrasound technologies in this clinical setting. The combination of pulsed tissue Doppler study of mitral annulus with transmitral inflow may be clinically valuable for obtaining information about left ventricular filling pressure (LVFP) and unmasking Doppler inflow pseudonormal pattern, a hinge point for the progression toward advanced heart failure. In the absence of epicardial coronary artery stenosis, the ultrasound assessment of coronary flow reserve (CFR) may identify the dysfunction of coronary microcirculation, in relation with glycemic levels, insulin resistance, sympathetic overdrive, endothelial dysfunction, abnormalities of the angiotensin-renin system, and LV remodeling/hypertrophy. Diastolic dysfunction and impairment of CFR may be associated in DM, with a likely common origin. In this view, a comprehensive transthoracic Doppler evaluation of diabetic patients should include the assessment of diastolic function and estimation of LVFP by tissue Doppler, and coronary microvascular function by CFR test. Additional analysis of regional wall motion during a stress test would be required in patients with suspected coronary artery disease, another cause of diastolic dysfunction.
|
Abbreviations and Acronyms
| | CAD = coronary artery disease | | CFR = coronary flow reserve | | DD = diastolic dysfunction | | DM = diabetes mellitus | | LV = left ventricular | | LVFP = left ventricular filling pressure |
|
This article has been cited by other articles:
|
|
|
|
 
H. Nakai, M. Takeuchi, T. Nishikage, R. M. Lang, and Y. Otsuji
Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration
Eur J Echocardiogr,
December 1, 2009;
10(8):
926 - 932.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Moreo, G. Ambrosio, B. De Chiara, M. Pu, T. Tran, F. Mauri, and S. V. Raman
Influence of Myocardial Fibrosis on Left Ventricular Diastolic Function: Noninvasive Assessment by Cardiac Magnetic Resonance and Echo
Circ Cardiovasc Imaging,
November 1, 2009;
2(6):
437 - 443.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Biondi, M. Galderisi, L. Pagano, M. Sidiropulos, M. Pulcrano, A. D' Errico, S. Ippolito, A. Rossi, O. de Divitiis, and G. Lombardi
Endothelial-mediated coronary flow reserve in patients with mild thyroid hormone deficiency
Eur. J. Endocrinol.,
August 1, 2009;
161(2):
323 - 329.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. E. Hofsten, B. B. Logstrup, J. E. Moller, P. A. Pellikka, and K. Egstrup
Abnormal glucose metabolism in acute myocardial infarction influence on left ventricular function and prognosis.
J. Am. Coll. Cardiol. Img.,
May 1, 2009;
2(5):
592 - 599.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. B. Lindsey and S. P. Marso
Steatosis and Diastolic Dysfunction The Skinny on Myocardial Fat.
J. Am. Coll. Cardiol.,
November 25, 2008;
52(22):
1800 - 1802.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. B. Dokken
The Pathophysiology of Cardiovascular Disease and Diabetes: Beyond Blood Pressure and Lipids
Diabetes Spectr,
July 1, 2008;
21(3):
160 - 165.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Cheung, J. J. Wang, S. L. Rogers, F. Brancati, R. Klein, A. R. Sharrett, T. Y. Wong, and for the ARIC (Atherosclerosis Risk In Communities)
Diabetic retinopathy and risk of heart failure.
J. Am. Coll. Cardiol.,
April 22, 2008;
51(16):
1573 - 1578.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D H MacIver and M Townsend
A novel mechanism of heart failure with normal ejection fraction
Heart,
April 1, 2008;
94(4):
446 - 449.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Z. Li, T. Zhang, H. Dai, G. Liu, H. Wang, Y. Sun, Y. Zhang, and Z. Ge
Endoplasmic reticulum stress is involved in myocardial apoptosis of streptozocin-induced diabetic rats
J. Endocrinol.,
March 1, 2008;
196(3):
565 - 572.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. LaCroix, J. Freeling, A. Giles, J. Wess, and Y.-F. Li
Deficiency of M2 muscarinic acetylcholine receptors increases susceptibility of ventricular function to chronic adrenergic stress
Am J Physiol Heart Circ Physiol,
February 1, 2008;
294(2):
H810 - H820.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. M. Witteles and M. B. Fowler
Insulin-Resistant Cardiomyopathy: Clinical Evidence, Mechanisms, and Treatment Options
J. Am. Coll. Cardiol.,
January 15, 2008;
51(2):
93 - 102.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Cortigiani, F. Rigo, S. Gherardi, R. Sicari, M. Galderisi, F. Bovenzi, and E. Picano
Additional Prognostic Value of Coronary Flow Reserve in Diabetic and Nondiabetic Patients With Negative Dipyridamole Stress Echocardiography by Wall Motion Criteria
J. Am. Coll. Cardiol.,
October 2, 2007;
50(14):
1354 - 1361.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Ashrafian, M. P. Frenneaux, and L. H. Opie
Metabolic Mechanisms in Heart Failure
Circulation,
July 24, 2007;
116(4):
434 - 448.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
