02549nas a2200193   4500000000100000008004100001100001600042700001300058700001200071700001700083700001200100700001300112245008100125250001500206300001200221490000600233520206500239020005102304       2015                            d1 aHeritier S.1 aLeung M.1 aPhan V.1 aWhatmough M.1 aWong V.1 aLeung D.00aLeft ventricular diastolic reserve in patients with type 2 diabetes mellitus  a2015/04/22  ae0002140 v23 a<p>
AIMS: Diastolic reserve is the ability of left ventricular filling pressures to remain normal with exercise. Impaired diastolic reserve may be an early sign of diabetic cardiomyopathy. We aimed to determine whether diastolic reserve differs in type 2 diabetes (DM) compared with non-DM, and to identify clinical, anthropological, metabolic and resting echocardiographic correlates of impaired diastolic reserve in patients with DM. METHODS AND RESULTS: 237 patients (aged 53+/-11 years, 133 DM, ejection fraction 68+/-9%) underwent rest and exercise echocardiography. Mitral E and septal e' were measured at rest, immediately post, and 10 min into recovery. Analysis of covariance (ANCOVA) and binary regression with continuous outcomes were used to model e' and E/e' changes with exercise to identify impaired diastolic reserve defined as post-exercise E/e'&gt;/=15. After adjusting for baseline differences, patients with DM immediately post-exercise had a lower septal e', a lower Deltae' (1.2 vs 2.3 cm/s, p=0.006) and a higher Delta septal E/e' (1.7 vs 0.08, p&lt;0.001) than patients without DM. In patients with normal resting E/e' of <!--=8 (n=130), DM had a significantly higher post-exercise septal E/e' and a higher Deltaseptal E/e' (2.63 vs 0.50, p<0.001). E/e' in patients with DM remained significantly elevated up to 10 min post-exercise. Hypertension, longer duration of insulin therapy, poorer glycaemic control, worse renal function, larger left atrial volume and lower septal e' were independent correlates of impaired diastolic reserve in patients with DM. CONCLUSIONS: Patients with DM have impaired diastolic reserve manifest as a blunted e' response with exercise, persisting into recovery. Clinical, anthropometric, metabolic and echocardiographic correlates of impaired diastolic reserve in patients with DM were identified. An impaired LV diastolic reserve may be the underlying pathophysiological mechanism in patients with DM with unexplained exertional dyspnoea and may allow earlier detection of DM cardiomyopathy.-->
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  a2053-3624 (Electronic)<br/>2053-3624 (Linking)