Impact of left ventricular longitudinal diastolic functional reserve on clinical outcome in patients with type 2 diabetes mellitus

Sung-Ai Kim; Chi-Young Shim; Jin-Mi Kim; Hyun-Jin Lee; Dong-Hoon Choi; Eui-Young Choi; Yangsoo Jang; Namsik Chung; Jong-Won Ha
August 2011
Heart;Aug2011, Vol. 97 Issue 15, p1233
Academic Journal
Background Left ventricular longitudinal diastolic functional reserve (DFR), as assessed by the change in early diastolic mitral annular velocity (E') during exercise, is abnormal in patients with type 2 diabetes mellitus (DM). However, the impact of left ventricular longitudinal DFR on clinical outcome has not been explored. This study evaluated the incremental prognostic value of left ventricular DFR in patients with type 2 DM without overt heart disease. Methods Of 1485 patients who were referred for exercise stress echocardiography, 197 consecutive patients (mean age, 58 years; 84 men) with type 2 DM without overt heart disease were identified. Left ventricular longitudinal DFR was defined as the change in E9 from resting to exercise (ΔE'). The endpoint was a composite of death and hospitalisation for heart failure (HF). Results During a median follow-up of 57 months (range 6e90), 18 of 197 patients (9.1%) had adverse events (12 deaths, six hospitalisations for HF). Independent predictors of adverse events in a Cox regression analysis were estimated glomerular filtration rate (HR 0.97; 95% CI 0.95 to 0.98; p<0.001), DM duration (HR 1.07; 95% CI 1.01 to 1.14; p=0.018) and ΔE' (HR 0.58; 95% CI 0.40 to 0.85; p=0.005). In an incremental model, the addition of stress echo data significantly increased the χ2 of the clinical and resting left ventricular function model, from 40.5 to 46.6 (p=0.005). Conclusion Assessment of left ventricular longitudinal DFR during exercise provided incremental prognostic information in patients with type 2 DM without overt heart disease.


Related Articles

  • Development and validation of a risk score for hospitalization for heart failure in patients with Type 2 Diabetes Mellitus. Xilin Yang; Ma, Ronald C.; Wing-Yee So; Kong, Alice P.; Ko, Gary T.; Chun-Shun Ho; Lam, Christopher W.; Cockram, Clive S.; Tong, Peter C.; Chan, Juliana C. // Cardiovascular Diabetology;2008, Vol. 7, p1 

    Background: There are no risk scores available for predicting heart failure in Type 2 diabetes mellitus (T2DM). Based on the Hong Kong Diabetes Registry, this study aimed to develop and validate a risk score for predicting heart failure that needs hospitalisation in T2DM. Methods: 7067 Hong Kong...

  • The Utility of Carotid Ultrasonography in Identifying Severe Coronary Artery Disease in Asymptomatic Type 2 Diabetic Patients Without History of Coronary Artery Disease. IRIE, YOKO; KATAKAMI, NAOTO; KANETO, HIDEAKI; NISHIO, MAYU; KASAMI, RYUICHI; SAKAMOTO, KEN'YA; UMAYAHARA, YUTAKA; SUMITSUJI, SATORU; UEDA, YASUNORI; KOSUGI, KEISUKE; SHIMOMURA, IICHIRO // Diabetes Care;May2013, Vol. 36 Issue 5, p1327 

    OBJECTIVE--Although many studies have shown that carotid intima-media thickness (IMT) is associated with coronary artery disease (CAD), it remains inconclusive whether assessment of carotid IMT is useful as a screening test for asymptomatic but severe CAD in diabetic patients. RESEARCH DESIGN...

  • Plasma leptin level is associated with cardiac autonomic dysfunction in patients with type 2 diabetes: HSCAA study. Masafumi Kurajoh; Hidenori Koyama; Manabu Kadoya; Mariko Naka; Akio Miyoshi; Akinori Kanzaki; Miki Kakutani-Hatayama; Hirokazu Okazaki; Takuhito Shoji; Yuji Moriwaki; Tetsuya Yamamoto; Masanori Emoto; Masaaki Inaba; Mitsuyoshi Namba // Cardiovascular Diabetology;9/4/2015, Vol. 14 Issue 1, p1 

    Background: It has been shown that visceral fat accumulation is associated with autonomic dysfunction, though the precise mechanism remains unclear. A recent basic study found that leptin can directly modulate autonomic function through the dorsomedial hypothalamus in relation to obesity. Here,...

  • Estimation of 10-Year Risk of Coronary Heart Disease in Nepalese Patients with Type 2 Diabetes: Framingham Versus United Kingdom Prospective Diabetes Study. Ram Pokharel, Daya; Khadka, Dipendra; Sigdel, Manoj; Kishor Yadav, Naval; Bahadur Sapkota, Lokendra; Kafle, Ramchandra; Nepal, Sarthak; Mohan Sapkota, Ravindra; Choudhary, Niraj // North American Journal of Medical Sciences;Aug2015, Vol. 7 Issue 8, p347 

    Background: Predicting future coronary heart disease (CHD) risk with the help of a validated risk prediction function helps clinicians identify diabetic patients at high risk and provide them with appropriate preventive medicine. Aim: The aim of this study is to estimate and compare 10-year CHD...

  • ROADMAP and ORIENTAL Trials: the Re-emergence of J-Curve Ghost? Hamamoto, Yoshiyuki; Koshiyama, Hiroyuki // Japanese Clinical Medicine;2011, Issue 2, p25 

    It still remains unknown whether angiotensin-receptor blockers (ARBs) are cardioprotective in patients with type 2 diabetes. The recent two clinical trials, the ROADMAP and the ORIENT, have suggested that fatal cardiovascular events or cardiovascular deaths were unexpectedly higher in olmesartan...

  • Heart Rate Response During Positive Exercise Stress Test Predicts Coronary Artery Disease and Its Severity in High-Risk Type 2 Diabetic Patients With Silent Ischemia. Bacci, Simonetta; Iangialonga, Tommaso; Villella, Massimo; Rauseo, Anna; Fanelli, Raffaele; Trischitta, Vincenzo // Diabetes Care;Sep2003, Vol. 26 Issue 9, p2698 

    Examines the role of heart rate response during positive exercise stress test in predicting coronary artery disease and its severity in high risk type 2 diabetic patients with silent ischemia. Prediction of three-vessel disease in patients with maximal heart rate less than beats per minute.

  • Association of Hypoglycemia and Cardiac Ischemia. Desouza, Cyrus; Salazar, Holger; Cheong, Benjamin; Murgo, Joseph; Fonseca, Vivian // Diabetes Care;May2003, Vol. 26 Issue 5, p1485 

    OBJECTIVE — In some studies intensive diabetes treatment in patients with type 2 diabetes may be associated with increased cardiovascular events. It is not clear whether these events are related to hypoglycemic episodes. To determine whether episodes of hypoglycemia were more likely to be...

  • Enhancing macrovascular outcomes in DM2. Kuritzky, Louis // Clinical Oncology Alert;Aug2009 Supplement, p15 

    The article discusses research which investigated the outcome of various therapies in a group of patients with type 2 diabetes mellitus (DM2) with established coronary artery disease (CAD). It references a study published in the "New England Journal of Medicine." The therapies investigated...

  • New Study on Thiazolidinediones May Show Benefits. Elliott, William T. // Clinical Oncology Alert;Jun2008, Vol. 24 Issue 6, p1 

    The article discusses the results of a study which compares pioglitazone with sulfonylurea glimepiride measuring the progression of coronary atherosclerosis in patients with type 2 diabetes. Based on the study, glimepiride increased percent change in atheroma volume (PAV) by 0.73% while...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics