Influence of Type 2 Diabetes and the Sex on the Occurrence of Sub-Clinic Left-Ventricular Diastolic Dysfunction of the Heart

Open access


Aims: To test the hypothesis that: the potential of type 2 diabetes, in precipitation of the sub clinical left ventricular diastolic dysfunction at the female sex, in absence of high blood pressure disease, coronary disease and other known heart disease, is different in comparison to the male sex.

Material and Methods: Prospectively, 180 people with type 2 diabetes were tested, at the ages between 45 and 55, divided into 2 groups: 1) Control group- was comprised of 60 patients (30 male and 30 female), without diabetes, with similar epidemiological-demographic characteristics; 2) Diabetes group - was comprised of 120 patients (60 women and 60 men) with type 2 diabetes. The estimation of the diastolic function of the left ventricular was made by Doppler echocardiograph analysis of the diastolic time intervals, as well as analysis of the model of ventricular filling, shown with a transmitral flow-velocity profile, acquired with a conventional pulsed-wave Doppler.

Results: Significant changes between the groups in clinical variables were observed regarding body mass index, low density cholesterol and triglycerides, the variables gotten with the pulsed-wave Doppler of the transmitral flow, and the duration of the isovolumetric relaxation time.

Conclusions: In this study, we do not prove the hypothesis that the type 2 diabetes potential in the precipitation of the sub clinical left ventricular diastolic dysfunction at the female sex, in absence of coronary disease, blood pressure disease and other well known heart diseases, is different in comparison to the male sex.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1.Kannel WBMcGee DL. Diabetets and cardiovardiovascular risk factors: the Framingham study. Circulation. 1979;59:8-13.

  • 2.Fang ZYJohanes PMarwick TH. Diabetic Cardiomyopathy: Evidence Mekanismsand therapeutic implication.Endocrine Riews. 2004;25(4):543-67.

  • 3.Marwick TH. Diabetic Heart Disease. Heart. 2006;92:296-300.

  • 4.Di Bonito PCuomo SMoio Net al. Diastolic Disfunction in patient with non insulin-dependent diabetes mellitus of short duration. Diabet Med.1996;13:321-4.

  • 5. Inoue T Fujito T Asahi S et al. Impaered of levt ventriculary diastolic filing occur in diabetic patient without atherosclerotic coronary artery disease. Am J Med Sci.1997;313:125-30.

  • 6. Cerutti F Vigo A Sacchetti C Bessone A Barattia G Morello M Casalucci D Gastaldi L. Evaluation of left ventricular diastolic function in insulin dependent diabetic children by M-mode and Doppler echocardiography. Panminerva Med. 1994;36(3):109-14.

  • 7. Rajan SK Gokhale SM. Cardiovaskular function in patient with insulin-dipiendent diabetes mellitus: a stady using noninvasive methods. Ann NY Acad Sci. 2002;958:425-30.

  • 8. Semeniuk LK Kryski AJ Severson DL. Echocardiographic assessment of cardiac fungtion in diabetic db/dp and ransgenic db/db-hGLUT4 mice. Am J Physiol Heart Circ Physiol. 2002.283:H976-H982.

  • 9. Ganguly PK Thliversis JA Mehta A. Evidence against the involvement of nonenzymatic glycosylation in diabetic cardiomyopethy. Metabolism. 1990;39:769-73.

  • 10. Shimizu M Sugihara N Kita Y Shimizu K Shibayama S Takeda R. Increase in left ventricular chamber stiffness in patients with non-insulin dependent diabetes mellitus. Jpn Circ J. 1991; 55:657-664.

  • 11. Bouchard A Sanz N Botvinick EH et al. Noninvasive assessment of cardiomyopathy in normotensive diabetic patients between 20 and 50 years old. AmJ Med. 1989;87:160-66.

  • 12. Airaksinen J Ikaheimo M Kaila J et al. Impaired left ventricular filling in young female diabetics. An echocardiographic study. Acta Med Scand. 1984; 216: 509-516.

  • 13. Strauer BE Motz W Vogt M et al. Impaired coronary flow reserve in NIDDM: a possible role for diabetic cardiopathy in humans. Diabetes. 1997; 46(Suppl 2):S119- S1247.

  • 14. Poirier P Bogaty P Garneau C et al. Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes: importance of maneuvers in echocardiographic screening for preclinical diabetic cardiomyopathy. Diabetes Care. 2001; 24:5-10.

  • 15. Schannwell CM Schneppenheim M Perings S Plehn G et al. Left ventricular diastolic dysfunction as an early manifestation of diabetic cardiomyopathy. Cardiology. 2002; 98: 33-39.

  • 16. Paillole C Dahan M Paycha F et al. Prevalence and significance of left ventricular filling abnormalities determined by Doppler echocardiography in young type I (insulindependent) diabetic patients. Am J Cardiol. 1998;64:1010-1016.

  • 17. Zabalgoitia M Ismaeil MF Anderson L et al. Prevalence of diastolic disfunction in normotenzive asymptomatic patient with well-controlled type-2 diabetes mellitus. Am J Cardiol. 2001;87:320-3.

  • 18. Shehadeh A Regan TJ. Cardiac consequences of diabetes mellitus. Clin Cardiol. 1995;18:301-305.

  • 19. Tokushima T Reid CL Gardin JM. Levt ventricular diastolic function in the elderly. Am J Geriatr Cardiol. 2001;10(1):20-9.

  • 20. Mathew P John L Jose J Krishnaswami S. Assessment of left ventricular diastolic function in young diabetics- a two dimensional echo Doppler study. Indian Heart J. 1992;44:29-32.

  • 21. Mottrm Ph Marwick. Assesment of diastolic function:what the general cardiologist need to know. Heart. 2005;91:681-695.

  • 22. Joffe II Travers KE Perreault-Micale CL et al. Abnormal cardiac function in the streptozotocin-induced non-insulindependent diabetic rat: noninvasive assessment with Doppler echocardiography and contribution of the nitric oxide pathway. J Am Coll Cardiol. 199;34:2111-2119.

  • 23. Wold LE Relling DP Colligan PB et al. Characterization of contractile function in diabetic hypertensive cardiomyopathy in adult rat ventricular myocytes. J Mol Cell Cardiol. 2001;33:1719-1726.

  • 24. Hoit BD Castro C Bultron G et al. Noninvasive evaluation of cardiac dysfunction by echocardiography in streptozotocininduced diabetic rats. J Card Fail.1999; 5:324-333.

  • 25. Friedman NE Levitsky LL Edidin DV et al. Echocardiographic evidence for impaired myocardial performance in children with type I diabetes mellitus. Am J Med. 1982;846-50.

  • 26. Mbanya JC Sobngwi E Mbanya DS et al. Left ventricular mass and systolic function in African diabetic patients: association with microalbuminuria. Diabetes Metab. 2001; 27:378-382.

  • 27. Fang ZY Yuda S Anderson V et al. Echocardiographic detection of early diabetic myocardial disease. J Am Coll Cardiol. 2003;41:611-617.

  • 28. Scognamiglio R Casara D Avogaro A. Myocardial dysfunction and adrenergic innervation in patients with type 1 diabetes mellitus. Diabetes Nutr Metab. 2000;13:346-349.

  • 29. Baum VC Levitsky LL Englander RM. Abnormal cardiac function after exercise in insulin-dependent diabetic children and adolescents. Diabetes Care. 1987;10:319-323.

  • 30. Vered A Battler A Segal P et al. Exercise-induced left ventricular dysfunction in young men with asymptomatic diabetes mellitus (diabetic cardiomyopathy). Am J Cardiol. 1984;54:633-637.

  • 31. Carlstrom S Karlefors T. Haemodynamic studies on newly diagnosed diabetics before and after adequate insulin treatment. Br Heart J. 1970;32:355-358.

  • 32. Karlefors T. Haemodynamic studies in male diabetics. Acta Med Scand. 1966;449:45-80.

  • 33. Nugent AM Steele IC al Modaris F et al. Exercise responses in patients with IDDM. Diabetes Care. 1997;20:1814-1821.

  • 34. Fang ZY Yuda S Anderson V et al. Echocardiographic detection of early diabetic myocardial disease. J Am Coll Cardiol. 2003;41:611-617.

  • 35. Thompson EW. Structural manifestations of diabetic cardiomyopathy in the rat andits reversal by insulin treatment. Am J Anat. 1988;182:270-282.

  • 36. Liu JE Palmieri V Roman MJ et al. The impact of diabetes on the levt ventricular filling patern in normotensive and hypertensive adult:the strong heart study. J Am Coll Cardiol. 2001;37:1943-9.

  • 37. Ruter MK Parisie H Benjamin EJ et al. Impact of glucose tolerance and insulin resistance on cardiac structure and function:sex-related differences in the Frmingham heart study. Circulation. 2003;107:448-54.

  • 38. Watts GF Marwick TH. Ventricular disfunction in early diabetic heart disease:detection mechanisms and significance. Clin Sci(Lond). 2003;105:537-40.

  • 39. Frustaci A Kajstura J Chimenti C et al. Myocardial cell death in human diabetes. Circ Res. 2000;87:1123-11326.

  • 40. Cai L Li W Wang G et al. Hyperglycemia-induced apoptosis in mouse myocardium: mitochondrial cytochrome C-mediated caspase-3 activation pathway. Diabetes. 2002; 51:1938-1948.

  • 41. Sonnenblick EH Fein F Capasso JM et al. Microvascular spasm as a cause of cardiomyopathies and the calcium-blocking agent verapamil as potential primary therapy. Am J Cardiol. 1985;55:179B-184B.

  • 42. Nakano S Kitazawa M Ito T et al. Insulin resistant state in type 2 diabetes is related to advanced autonomic neuropathy. Clin Exp Hypertens. 2003;25:155-167.

  • 43. Factor SM Minase T Cho S et al. Coronary microvascular abnormalities in the hypertensive-diabetic rat. A primary cause of cardiomyopathy? Am J Pathol. 1984;116:9-20.

  • 44. Blumenthal HT Alex M Goldenberg S. A study of lesions of the intramural coronary branches in diabetes mellitus. Arch Pathol. 1960;70:27-42.

  • 45. Stephanije KI Rolf HA Ruth JM et al. Pre-clinical diabetic cardiomyopathy: Prevalence screening and outcome. Eur J Heart Failure. 2010;12:951-57.

  • 46. Sunni S Bishop SP Kent SP et al. Diabetic cardiomyopathy. A morphological study of intramyocardial arteries. Arch Pathol Lab Med. 1986;110:375-381.

  • 47. Sutherland CG Fisher BM Frier BM et al. Endomyocardial biopsy pathology in insulin-dependent diabetic patients with abnormal ventricular function. Histopathology. 1989;14:593-602.

  • 48. Strauer BE Motz W Vogt M et al. Impaired coronary flow reserve in NIDDM: a possible role for diabetic cardiopathy in humans. Diabetes. 1997;46(Suppl 2):S119-S.

  • 49. Pitkanen OP Nuutila P Raitakari OT. Coronary flow reserve is reduced in young men with IDDM. Diabetes. 1998;47:248-254.

  • 50. Yokoyama I Ohtake T Momomura S et al. Hyperglycemia rather than insulin resistance is related to reduced coronary flow reserve in NIDDM. Diabetes. 1998;47:119-124.

  • 51.Ganguly PK Pierce GN Dhalla KS et al. Defective sarcoplasmic reticular calcium transport in diabetic cardiomyopathy. Am J Physiol. 1983;244:E528-E535.

  • 52. Calles-Escandon J Cipolla M. Diabetes and endothelial dysfunction: a clinical perspective. Endocr Rev. 2001;22:36-52.

  • 53. Pitkanen OP Nuutila P Raitakari OT et al. Coronary flow reserve is reduced in young men with IDDM. Diabetes. 1998;47:248-2545.

  • 54. Taylor PD Graves JE Poston L. Selective impairment of acetylcholine-mediated endothelium-dependent relaxation in isolated resistance arteries of the streptozotocin-induced diabetic rat. Clin Sci (Lond). 1995;88:519-524.

  • 55. Koya D King GL. Protein kinase C activation and the development of diabetic complications. Diabetes. 1998;47:859-866.

  • 56. Turpeinen AK Vanninen E Kuikka JT et al. Demonstration of regional sympathetic denervation of the heart in diabetes. Comparison between patients with NIDDM and IDDM. Diabetes Care. 1996;19:1083-1090.

  • 57. Felten SY Peterson RG Shea PA et al. Effects of streptozotocin diabetes on the noradrenergic innervation of the rat heart: a longitudinal histofluorescence and neurochemical study. Brain Res Bull. 1982;8:593-600.

  • 58. Uekita K Tobise K Onodera S. Enhancement of the cardiac ß-adrenergic system at an early diabetic state in spontaneously diabetic Chinese hamsters. Jpn Circ J. 1997;61:64-73.

  • 59. Bajraktari G Qirko S Rexhepaj N Bakalli A Beqiri A Elezi S Ndrepepa G. Non-insulin dependent diabetes as an independent predictor of asymptomatic left ventricular diastolic dysfunction. Croat Med J. 2005;46(2):225-31.

  • 60. Mustonen JN Uusitupa MI Laakso M et al. Levt ventricular systolic function in mioddle-aged patient with diabet mellitus. Am J Cardiol.1994;73:1202-8.

  • 61. Rejn J Ceylian-Isik AF. Do women differ from men? Endocrine. 2004;25(2):73-83.

  • 62. Suys BE Katier NR Rooman RP et al. Female children and adolescents with diabetes mellitus have more pronounced early echocardiographic signs of diabetic cardiomyopathy. Diabetes Care. 2004;27(8):2081-3.

  • 63. Ida G Bente B Marie S et al. Influence of diabetes and diabetes -genger interaction on the risk of death inpatient hospitalized with congestive heart failure. JACC. 2004;43:771-777.

  • 64. Stephanije K Rolf H Ruth D et al. Pre-clinical diabetic cardiomyopathy: Prevalence screening and outcome. Eur J Heart. 2010;12:951-57.

  • 65. Cosson S Kevorkijan JP Virally ML et al. No evidence for levt ventricular diastolic disfunktion in asymptomatic normotenzive type-2 diabetic patiets: a case-control study with new echocardiographic techniques. Diabetes Metab. 2007;33(1):61-67.

  • 66. Boyer JK Thanigaraj S Schecht KB et al. Prevalence of ventricular disfunction in asymptomatic normotesive patient with dibetes mellitus. Am J Cardiol. 2004;93(7):870-5.

  • 67. Redfield MM Jakobsen SJ Burnet JC et al. Burden of systolic and diastolic ventricular dysfunction in the community:appreciating the scope of the heart fealure epidemic. JAMA. 2003;289:194-202.

  • 68. Vanninen E Mustonen J Vainio P et al. Levt ventricular fungction and dimension in newly diagnosed non-insulin - dependent diabetes mellitus. Am J Cardiol. 1992;70:371.

  • 69. Fiorini G Scotti LA Parmigiani ML Ferrari M Pezzoli P Bignotti G. [An echocardiographic study of left ventricular diastolic function in patients with diabetes mellitus type 2]. G Ital Cardiol. 1995;25(1):17-25.

  • 70. Luuk JR Rudger VM Johannes WS et al. Myocardial steatosis is an independent predictor of diastolic disfungcijon in type-2 diabetes mellitus. J Am Coll Cardiol. 2008.52;(22):1793-99.

  • 71. Vinereanu D Nicolaides E Tweddel AC et al. Subclinicl levt ventriculary disfunction in patient with type-2 diabetes mellitus related to serum lipids and glycated haemoglobin. Clin Sci (Lond). 2003;105(5):537-40.

  • 72. America Diabetes Association. Standards for medical care for patient with diabetes mellitus. Diabetes Care. 2002;25(Suppl 1 0:S33-S49.

  • 73. The Seventh Report of Joint National Committee on PDET of High Blood Preassure. May 2003. NIH Publication No03-5233.

  • 74. Schiller NB Shah PM Crawford M et al. American Society of Echocardiography Committe on standards subcommittee on Quantifications of Two-Dimensional echocardiograms: Recomandations for quantifications of left ventricle by two- dimensional echocardiography. J Am Soc Echocardiography. 1989;2:258-67.

  • 75. How to diagnose diastolic heart failure. European Study Group on Diastolic Heart Failure. Eur Heart J. 1998;19:900-1003.

  • 76. Dewereux R Alonson DR Lutas EM. Echocardiographic assessment of levt ventricular hypertrophy: comparison to necropsy findings. Circulation. 1986;57:450-85.

  • 77. Hense HW Gneiting B Muscholl M et al. The associacions the body size and body composition with left ventricular mass: impacts for indexation in adult. J Am Coll Cardiol. 1998;32:451-457.

  • 78. ACC/AHA. Guide line Update.Diagnosis and Management of Chronic Heart Failure in the Adult. J Am Coll Cardiol. 2005;46:1117-39.

Journal information
Impact Factor

CiteScore 2016: 0.16

SCImago Journal Rank (SJR) 2016: 0.136
Source Normalized Impact per Paper (SNIP) 2016: 0.141

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 125 60 8
PDF Downloads 51 28 2