Published Online
on October 21, 2009

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Original Article

Left Ventricular Diastolic Function in Type 2 Diabetes Mellitus: Prevalence and Association with Myocardial and Vascular Disease

Mikael Kjaer Poulsen^1,4; Jan Erik Henriksen¹; Jordi Dahl¹; Allan Johansen¹; Oke Gerke²; Werner Vach²; Torben Haghfelt¹; Poul Flemming Høilund–Carlsen¹; Henning Beck-Nielsen¹ and Jacob Eifer Møller³

¹ Odense University Hospital, Odense, Denmark;
² University of Southern Denmark, Odense, Denmark;
³ Copenhagen University Hospital & Rigshospitalet, Copenhagen, Denmark

^* Corresponding author; email: doc_mkp{at}hotmail.com

Background—Although, type 2 diabetes mellitus (T2DM) is a risk factor for developing congestive heart failure the mechanism leading to heart failure is unclear. We examined the prevalence of left ventricular (LV) systolic and diastolic dysfunction in T2DM patients in relation to vascular function and myocardial perfusion.

Methods and Results—In a prospective observational study 305 T2DM patients (diabetes duration: 4.5±5.3 years) referred consecutively to a diabetes clinic for the first time were screened for LV systolic and diastolic function by echocardiography. Vascular function was estimated using noninvasive estimation of pulse pressure, carotid arterial compliance, total arterial compliance, and valvulo-arterial impedance. The prevalences of LV diastolic dysfunction and left atrial volume index (LAVI) >32 ml/m² were 40% and 32%, respectively. The prevalence of myocardial ischemia on myocardial perfusion scintigraphy (MPS) was more frequent in patients with grade 2 diastolic dysfunction and LAVI >32 ml/m² compared with those having normal or grade 1 diastolic dysfunction (p=0.002) or LAVI 32 ml/m² (p<0.001), respectively. Predictors of grade 2 diastolic dysfunction and LA dilatation were summed stress score (SSS) on MPS, total arterial compliance, and valvulo-arterial impedance, whereas pulse pressure and carotid arterial compliance were not, after adjusting for age, male gender, and diabetes duration. On multivariable modeling, SSS (p<0.001) and valvulo arterial impedance (p=0.027) remained predictors of grade 2 diastolic dysfunction, and only SSS (p<0.001) was a predictor of LA dilatation.

Conclusion—Abnormal LV filling is closely associated with abnormal myocardial perfusion on MPS, whereas the association of LV filling with vascular function is less prominent.

Key Words: left ventricular diastolic dysfunction • left atrial volume index • myocardial perfusion • type 2 diabetes mellitus • vascular function