Effects of blood pressure lowering and metabolic control on systolic left ventricular function in Type II diabetes mellitus.
ABSTRACT Decreased left ventricular long-axis function may be the earliest stage in subclinical heart failure in Type II diabetes. To assess whether a decrease in SBP (systolic blood pressure) or a change in metabolic control would improve the long-axis function, 48 Type II diabetic patients participating in the CALM II (Candesartan and Lisinopril Microalbuminuria II) study were included in the present study. Patients were examined with tissue Doppler echocardiography at baseline and after 3 and 12 months of follow-up. Corresponding blood pressure, fructosamine and HbA(1c) (glycated haemoglobin) values were obtained. During the follow-up period, a decrease in SBP of 8 mmHg was seen (from 141+/-11 mmHg at baseline to 133+/-12 mmHg; P<0.001) and the peak systolic strain rate was significantly improved (from -1.10+/-0.25 at baseline to -1.25+/-0.22; P<0.01). There was a highly significant relationship between the changes in systolic strain rate, HbA(1c) (P<0.001) and fructosamine (P<0.05), and similarly to changes in left ventricular mass (P<0.05), whereas the correlation to the SBP reduction was not significant. Patients with improved glycaemic control, defined as a reduced HbA(1c) value after 12 months of follow-up, had a significantly improved strain rate (from -1.07+/-0.3 s(-1) at baseline to -1.32+/-0.25 s(-1); P<0.01) compared with patients with increases in HbA(1c) (from -1.14+/-0.25 s(-1) at baseline to -1.16+/-0.27 s(-1); P=not significant). The two groups had comparable baseline values of SBP, left ventricular mass, age and disease duration. In conclusion, changes in left ventricular systolic long-axis function are significantly correlated with changes in left ventricular mass, as well as metabolic control, in hypertensive patients with Type II diabetes mellitus.
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ABSTRACT: Background: Impaired left ventricular (LV) function is shown by strain rate (SR) imaging in patients with diabetes mellitus (DM). Left atrium (LA) function in patients with DM, however, has not been assessed by this method and the effect of hypertension (HT) on LV and LA functions in diabetic patients has not been fully studied. The aim of this study was to quantitatively assess LA function in diabetic patients with and without HT in combination with LV function. Methods: Conventional echocardiographic and SR imaging studies were performed in 55 subjects with normal systolic LV function (LV ejection fraction of 55% or more) and no evidence of coronary artery disease: 17 with DM (DM group), 22 who have both DM and HT (DM+HT group), and 16 age-matched controls. SR imaging was performed from three apical views, and peak SR was measured at 12 LV segments and 5 LA segments. Mean peak systolic SR (LVs and LAs, respectively), early diastolic SR (LVe and LAe, respectively) and late diastolic SR (LVa and LAa, respectively) were calculated by averaging data in each LV and LA segment. Results: Despite no significant differences in age, LV ejection fraction and E/A ratio among the three groups, systolic blood pressure, LA dimension and LV mass index in the DM+HT group were significantly larger than those in the controls. The DM group had reduced systolic and diastolic LV functions and impaired LA reservoir and conduit functions compared with those in the controls, as shown by lower LVs (P < 0.05), LVe (P < 0.01), LAs (P < 0.01), and LAe (P < 0.05). The DM+HT group had reduced LVs (P < 0.01), LVe (P < 0.01), LAs (P < 0.01) and LAe (P < 0.01) compared with those in the controls. The DM+HT group had significantly lower LVe (P < 0.05) and LAe (P < 0.05) than did the DM group. Conclusions: SR imaging can detect impairment of LA reservoir and conduit functions as well as LV systolic and diastolic dysfunctions in patients with DM, even in the absence of LV hypertrophy and LA dilatation. Coexisting HT augments the impairment of LV diastolic and LA conduit functions in diabetic patients.Echocardiography 11/2008; 26(3):262 - 271. · 1.26 Impact Factor
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ABSTRACT: Although diabetes mellitus is well known to result in systolic and diastolic left ventricular (LV) dysfunction at the subclinical level, even when it is not accompanied by hypertension and coronary artery disease, this situation has not been sufficiently investigated in prediabetes, which is the precursor of diabetes. The aims of the present study were to investigate LV systolic and diastolic function in normotensive and low-risk prediabetic and diabetic subjects for coronary disease using sensitive tissue Doppler echocardiographic parameters, to investigate early possible negative effects of glucose metabolism impairment on LV longitudinal function. Two hundred subjects (92 with prediabetes, 48 with type 2 diabetes, and 60 age-matched healthy volunteers) were studied by conventional, tissue Doppler, and strain and strain rate echocardiography. All study subjects were normotensive, and coronary artery disease was excluded. Forty-eight patients had isolated fasting glucose impairment, and 44 patients had combined fasting glucose and glucose tolerance impairment. Longitudinal peak systolic strain and the peak systolic and diastolic strain rates of six walls in the apical four-chamber, long-axis, and two-chamber views were evaluated. Clinical and standard echocardiographic characteristics were comparable among all groups. Mean systolic (P = .01) and diastolic (P = .02) tissue velocities, mean strain (P = .004), and mean systolic (P = .002) and diastolic (P = .001) strain rates were significantly lower in the diabetic groups than in control subjects. There were no difference between patients with isolated fasting glucose impairment and controls for tissue Doppler parameters, but mean early diastolic tissue velocity and mean strain and strain rates were statistically lower in patients with combined fasting glucose and glucose tolerance impairment compared with controls (P < .05). LV longitudinal systolic and diastolic function was impaired in both normotensive diabetic and prediabetic patients.Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 12/2011; 25(3):349-56. · 2.98 Impact Factor
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ABSTRACT: Dan Med Bull 2010; 57: (6) B4150 THE EIGHT ORIGINAL PAPERS ARE: 1. Evaluation of the longitudinal contraction of the left ventricle in normal subjects by Doppler tissue tracking and strain rate Andersen NH, Poulsen SH J Am Soc Echocardiogr. 2003 Jul;16(7):716-23 2. Influence of preload alterations on parameters of systolic left ven-tricular long-axis function: a Doppler tissue study. Andersen NH, Terkelsen CJ, Sloth E, Poulsen SH J Am Soc Echocardiogr. 2004 Sep;17(9):941-7 3. Doppler tissue imaging reveals systolic dysfunction in patients with hypertension and apparent "isolated" diastolic dysfunction Poulsen SH, Andersen NH, Ivarsen PI, Mogensen CE, Egeblad H J Am Soc Echocardiogr. 2003 Jul;16(7):724-31 4. Diastolic dysfunction after an acute myocardial infarction in patients with antecedent hypertension Andersen NH, Karlsen FM, Gerdes JC, Kaltoft A, Bøttcher M, Sloth E, Thuesen L,Bøtker HE, Poulsen SH J Am Soc Echocardiogr. 2008 Feb;21(2):171-7 5. Decreased left ventricular longitudinal contraction in normotensive and normoalbuminuric patients with Type II diabetes mellitus: a Dop-pler tissue tracking and strain rate echocardiography study Andersen NH, Poulsen SH, Eiskjaer H, Poulsen PL, Mogensen CE Clin Sci (Lond). 2003 Jul;105(1):59-66 6. Left ventricular dysfunction in hypertensive patients with Type 2 diabetes mellitus Andersen NH, Poulsen SH, Poulsen PL, Knudsen ST, Helleberg K, Han-sen KW, Berg TJ, Flyvbjerg A, Mogensen CE Diabet Med. 2005; Sep;22(9):1218-25 7. Effects of blood pressure lowering and metabolic control on systolic left ventricular function in Type II diabetes mellitus Andersen NH, Poulsen SH, Poulsen PL, Knudsen ST, Helleberg K, Han-sen KW, Dinesen DS, Eiskjaer H, Flyvbjerg A, Mogensen CE Clin Sci (Lond). 2006 Jul;111(1):53-9 8. Changes in glycaemic control are related to the systolic function in type 1 diabetes mellitus Andersen NH, Hansen TK, Christiansen JS Scand Cardiovasc J. 2007 Apr;41(2):85-8 INTRODUCTION Congestive heart failure (CHF) is a disabling disease with consi-derable morbidity and mortality rates, despite great advances in heart failure treatment (1;2). The number of patients with congestive heart failure is rapidly increasing in the western world with a prevalence estimated at 1– 2 % and an incidence close to 5–10 per 1000 persons per year (3). The mounting congestive heart failure incidence is closely related to the increasing number of patients with hypertension and diabetes (4). The worldwide estimated number of adults with hypertension was 972 million in 2000; 639 million live in develop-ing countries. By 2025, the total number is expected to increase to 1·56 billion (5). The risk of developing CHF in a hypertensive cohort is about 2-fold in men and 3-fold in women as compared to normotensive individuals (4). Also in population based studies, hypertension is significantly related to development of CHF, ac-counting for 39 % of cases of CHF in men and 59 % in women (4). A similar exponential increase in type 2 diabetes incidence is evident. According to numbers from the WHO, there will be up to 366 million individuals with type 2 diabetes in 2030. The prevalence of CHF in a diabetic population is 5-8 fold higher compared to a non-diabetic population (6;7), and the risk of heart failure hospitalization in the UKPDS study was equal to that of non-fatal myocardial infarction, stroke or renal failure (8). Unfortunately, a large number of patients with diabetes mellitus have coexisting hypertension, which significantly increases the risk of heart failure dramatically (9;10). Hypertension and diabetes are both characterized by long asymp-tomatic periods, where patients are unaware of their subclinical diseases and thereby remain untreated (11). Recent data derived from the VALUE study showed that hypertensive patients with new-onset diabetes had significantly higher cardiac morbidity, especially increased congestive heart failure incidence, compared to hypertensive patients without diabetes (hazard ratio of 1.43Danish Medical Journal 06/2010; 57(6):B4150. · 0.61 Impact Factor
of Sm and Em and longer IRTm than their peers with normal insulin sensitivity.
Significant negative correlation between lasting plasma insulin and Sm was lound
out (r = - 0.57, p < 0.02).
Conclusion: In obese young women insulin resistance is related to deterioration
of LV systolic and diastolic function.
Effect of coexisting arterial hypertension and obesity on myocardial
deformation properties in a pediatric population
G. Di Salvo 1 , G. Pacileo 2 , M. Verrengia 2, F. Natale 2 , F. Fralta a, B. Cestaldi 2 ,
I~ Case 4 , R. Calabro 2 . 1Naples, Italy; 2Second University of Naples, Paediatric
Cardiology, Naples, Italy; 3Second University of Naples, Paediatric Cardiology,
Naples, Italy; 4 Monaldi Hospital, Department of Cardiology, Naples, Italy
Background: The impact of blood pressure elevation and obesity on cardiac lunc-
tion in children and adolescents has not been studied. New non-invasive echo
technique, such as Strain (S) (%) and Strain Rate (SR) (l/s) imaging has enhanced
our ability to study regional systolic myocardial functions.
Methods: In all we studied 150 subjects, 30 untreated hypertensive children
(Group H: mean age 124-3 years, 50% males,), 50 obese (BMI > 95th percentile
for age and s~0() children (Group O: mean age 114-3 years, 43% males), 40 obese
and hypertensive children (Group He: mean age 134-3 years, 56% males), and 30
age sex comparable heallhy children (clrls: mean age 124-3 years, 50% males). All
patients underwent slandard echocardiographic sludy and SR imaging evalulioa.
Peak systolic SR values were used for INs analysis. Hypertension was defined as
office syslolic or diastolic blood pressure >951h percenlile for age, se~ and heighl
on at least 2, diflerenl occasions.
Results: Group O (294-6 kg/n~) and He (314-6 kg/n~) presented increased BMI
compared to ctrls (184-3 kg/n~) and Group H pts (194-2 kg/m2). Systolic blood
pressure was higher in Group H (1314-17mmHg) than He (1294-25mmHg) than
in ctrls (1204-16 mmHg, p<0.05) and in Group O (1224-15 mmHg, p<0.05). Left
venlricular mass corrected for height 2.7 was increased (p<0.01) in pts compared
to ctrls, and among pts was significantly (p<0.01) higher in Group He. Global in-
dices el systolic lunction were similar in the 4 groups. Longitudinal deformation
properties were significantly reduced in pts (Group O: SR= -1.64-1 ; Group H: SR=
-1.54-0.9; Group He: SR= -1.44-0.8; Clrls: SR= -1.94-0.3), bul in Group He also
myocardial radial deformalion properlies (Group He: SR= 1.74-0.9) were signifi-
cantly reduced compared to clrls (SR= .3.24-1 ) and Group H (SR= 2.94-0.7) and
Group O (SR= 2.64-0.9). Right venlricle regional myocardial deformalion proper-
ties were comparable Io ctrls in Group H, while in Group O and He were signil-
icantly reduced (p<0.01 vs ctrls, p<0.01 vs Group H). Both radial and righl ven-
tricular myocardial delormation properties were significantly correlaled Io lasting
glycaemia (r=0.70; p<0.01).
Conclusions: This study shows thal children with obesity and hypertension have
a more severe reduction in myocardial delormation properties involving both radial
and longitudinal function as well as right and left ventricular lunction compared to
those with one disease or the other. SR imaging may be used as a relevant loci to
assess the influence el cardiovascular risk laclors on cardiac lunclion in high-risk
The effect of weight loss on lelt ventricular diastolic functions in obese
patients: a tissue Doppler imaging study
M. Melek 1 , G. Acarturk 2 , A. Avsar 1 , S. Yuksel 2, E. OnraI 1 I. Uslan 2, A. Celik 1 ,
E. Karaca 3 IKocatepe University School of Medicine, Department of Cardiology,
Afyon, Turkey; 2 Kocatepe University, School of Medicin, Department of Internal
Medicine, Afyon, Turkey; 3 Kocatepe University, School of Medicin, Department of
Dietetics and Nutrition, Afyon, Turkey
Aim: It has already known thal lelt ventricular (LV) diastolic functions deteriorate
in obesity. In INs sludy, we invesligale the effect of weight loss on LV diaslolic
funclions in obese palienls with tissue Doppler imaging (TDI).
Methods: Sevenly-four obese palients (52 lemale, mean age 44.84-10.5 years)
were included to the study. Mean body mass index (BMI) of palienls was 37.94-6.8
kg/m 2. Before the randomization, all comorbidilies were delecled and adequale
treatmenls regulated. The palienls with a history of cardiovascular disease and
other vilal organ lailure were excluded. All patients unden~venI conventional echo-
cardiography and TDI. The TDI mitral annular velocities were recorded lrom lateral
mitral annulus and mean of 5 consecutive cycles were calculated. Only lileslyle
modifications were recommended to obese patients lor weight loss therapy. Alter 6
months follow-up, patients were divided into two groups as weight loss more than
10% (group I, n=25) and less than 5% (group II, n=26).
Results: There were no digerences between two groups in age, gender, heart
rate, blood pressure, serum fasting glucose, plasma lipids, homeostasis model as-
sessment el insulin resistance, BMI, and convenlional echocardiographic and TDI
parameters during the first examinalion. Afler 6 months follow-up, improvement el
early diastolic mitral annular velocity was lound in group I compared wilh group II
(9.14-2.1 - 10.34-~.0, p <0.01 and 8.94-2.2 - 9.54-2.3, p >0.05, respeclively). This
difference was independenl from LV mass index. However, the mitral annular sys-
tolic velocity and late diastolic milral annular velocity did not aflecl Item 10% weighl
loss in 6 monlh.
Conclusions: These results suggested that reduce of LV diastolic lunclions are
reversible in obese patients. There may be a lavourable elfect el weight loss on LV
diastolic functions in obesity.
Effects of androgenic-anabolic steroids in myocardial function evaluated
by pulsed Doppler tissue imaging in bodybuilders athlets
R. Monlisci 1 , M. Ruscazio 2, M. Montisci 3, A. Porlale 2 , R. Snenghi s, L. Meloni 2 ,
S.D. Ferrara a, S. IliceIo 2 . ~ University of Cagliari, Chair of Cardiology, Cagliari,
Italy; 2University of Padova, Dept. of Cardiology, Padova, Italy; 3institute of
Forensic Medicine, University of Padova, Padova, Italy
Background: The androgenic anabolic steroids (AS) are used by bodybuilders
because they increase skelelal muscle mass. The AS can have adverse elfects
on the cardiovascular system. Pulsed Doppler myocardial imaging (PWDTI) is a
lechniquethaI evaluates syslolic and diaslolic myocardial velocities which vary wilh
alleration of regional venlricular funclion. The aim of this study was to investigale
lhe abilily el PWTDI to recognize lhe influence el AS use on regional myocardial
Methods: We studied 28 bodybuilders, 11 using AS (AS users), 17 at same train-
ing level, who had not used any drugs (non AS users) and 10, healthy sedentary
subjects (controls), matched in age and gender. At conventional echocardiographic
Doppler study lelt venlricular volume, ejection lraction, left venlricular mass, E/A
and isovolumic relaxation time (IRT) were evaluated. Peak systolic (S) myocardial
velocity, early diastolic (Ev) and late diastolic (Av) and IRT were measured using
PWDTI in four chamber view.
Results: Lell ventricular volume was significantly higher in AS users lhan in
non-AS users (714-12.2 ml/m 2 vs 60.94-6.39 ml/m 2 ,p<0.05) and lhan in controls
(714-12.2 ml/m 2 vs 59.14-5.8 ml/m2,p<0.05) AS users and non AS users had a
significant increase in lelI venlricular mass (96.7-t-~5 and 88.15-t-~6.5 g/m 2 re-
spectively) compared to controls (60..34-13.8 g/m 2 , p<0.05). Global syslolic func-
lion was the same in all subjects, bul IRT increased significanlly in AS users
compared to controls (77.74-16.6 vs 60.84-11.6 msec,p<0.05). At PWDTI anal-
ysis AS users had regional systolic and diastolic dyslunction compared to con-
Irols: reduced S (8.54-2.6 vs 11.24-1.9 cm/sec p<0.05, and 6.74-2.7 vs 10.384-3.2
cm/sec,p<0.05), and increased IRT (62.24-16 vs 394-5.4 msec, p<0.05 and
74.44-23.6 vs52.84-21.2 msec, p<0.05) at basal and medium lateral wall levels.
Furthermore lheAS users showed at PWDTI significantly higher IRT in compari-
son with non AS users (74.54-23.6 vs 51.344-12.05 msec, p<0.05).
Conclusion: Bodybuilders AS users have impaired syslolic and diastolic regional
myocardial function thal is possible Io delecl by PWTDI, despile normal global
LV function. Our study suggesls a negative role of AS in myocardial syslolic and
Effects of blood pressure lowering and metabolic control on systolic lelt
ventricular long axis function in type 2 diabetes mellitus
N.H. Andersen 1 , S.H. Poulsen 2 , P.L. Poulsen 3, C.E. Mogeesen 3. ~Aarhus
University Hospital, Department of Internal Medicine M, Aarhus, Denmark;
2Aarhus Universityhospital, Department of Cardiology, Aarhus, Denmark; 3Aarhus
University Hospital, Department of Internal Medicine M, Aarhus, Denmark
Background: Decreased left ventricular long axis function may be the earliest
slage in subclinical heart failure in lype 2 diabetes. To assess whether a decrease
in systolic blood pressure or a change in the melabolic control would improve lhe
long axis lunction, 48 type 2 diabetic patients parlicipating in the CALM II study
were included in the study.
The patients were examined wilh lissue Doppler echesardiography al baseline and
alter 3 and 12 months lollow-up, and corresponding blood pressure-, fructosamine-
and HbAlc -values were obtained.
Results: During the follow-up period there was a decrease in systolic blood pres-
sure el 7 mmHg (1404-10 to 1334-11 mmHg, p < 0.001) and the peak systolic
strain rate was significantly improved (-1.104-0.25 to -1.254-0.22, p < 0.01 ). There
was a highly significant relation between the changes in systolic SR and changes in
HbAlc (p<0.00f) and lructosamine (p<0.05) and a significant relation to changes
in LV mass (p<0.05), whereas the correlation Io lhe syslolic blood pressure re-
duclion was non-significanl. Patients with improved glycemic conlrol defined as a
reduced HbAfc value after 12 monlhs follow-up had a significantly improved SR
(-1.074- 0.3 to -1 ..324-0.25 p < 0.01) compared Io the palienls with increases in
HbAfc (-1.144- 0.25 to -1.164-0.27, p =NS). This despite comparable baseline val-
ues el systolic BP, lelI ventricular mass, age and disease duralion.
Conclusions: Changes in lelt ventricular syslolic long axis lunction is significantly
correlated to changes in metabolic control and changes in left venlricular mass, in
hypertensive patients with type 2 diabetes mellitus.
Response of subclinical myocardial dysfunction in diabetes mellitus to
T.H. Marwick 1 , N. Zhang 2, J. Sharman 2 , M. Hordern 2 , L. Smith 2 , J. Prins 2 .
University of Queensland, Head of Section, Dept. of Medicine, Brisbane,
Australia; 2University of Queensland, Dept of Medicine, Brisbane, Australia
Sensilive markers of Iongiludinal LV funclion have identified LV dyslunction in
asymplomatic subjects with type II diabeles (TIIDM). Insulin resistance is believed
I0 be an important conlribulor. In lhis study, we sought whether a short-lerm exer-
cise and diet intervention program could reverse this phenomenon.
Methods: We recruited 140 pls with TIIDM, without a history ol cardiac disease
and a normal stress echo. Baseline data were gathered on clinical status, exercise
Eur J Echocardiography Abstracts Supplement, December 2005
by guest on February 25, 2013