Left Ventricular Dysfunction and Blood Glycohemoglobin Levels in Young Diabetics

Left ventricular function including regional wall motion (RWM) was evaluated by ^99mTc first-pass and equilibrium gated blood pool ventriculography and glycohemoglobin (HbA1c) blood levels determined by a quantitative column technique in 25 young patients with insulin-dependent diabetes mellitus without clinical evidence of heart disease, and in healthy controls matched for age and sex. Phase analysis revealed abnormal RWM in 19 of 21 diabetic patients. The mean left ventricular global ejection fraction, the mean regional ejection fraction and the mean 1/3 filling fraction were lower and the time to peak ejection, the time to peak filling and the time to peak ejection /cardiac cycle were longer in diabetics than in controls. We found high HbA1c levels in all diabetics. There was no significant difference between patients with and without retinopathy and with and without peripheral neuropathy in terms of left ventricular function and HbA1c levels.

Zusammenfassung

Es wurden mittels ^99mTc-Ventrikulographie die linksventrikulären Funktionsparameter, einschließlich der regionalen Wandbewegung (RWM), und mittels einer quantitativen Säulentechnik die Glykohämoglobin-Werte (HbAlc) im Blut bei 25 jungen Patienten mit insulinabhängigem Diabetes mellitus ohne klinische Zeichen einer Herzerkrankung bestimmt; als Kontrolle dienten Gesunde passenden Geschlechts und Alters. Die Phasenanalyse zeigte bei 19/21 Diabetikern abnorme RMWs. Die mittlere linksventrikuläre globale Auswurffraktion, die mittlere regionale Auswurffraktion und die mittlere 1/3 Füllungsfraktion waren bei den Diabetikern niedriger und die “Time to Peak Ejection”, die “Time to Peak Filling” und die “Time to Peak Ejection” pro Herzschlag länger als bei den Kontrollen. Die HbAlc-Werte waren bei allen Diabetikern erhöht. Hinsichtlich der linksventrikulären Funktion und der HbAlc-Werte fand sich kein signifikanter Unterschied zwischen Patienten mit und ohne Retinopathie bzw. mit und ohne neurologische Störungen.

• REFERENCES

• 1 Bhimji S, Godin DY, Me JHNeil. Biochemical and functional changes in hearts from rabbits with diabetes. Diabetologia 1985; 26: 452-7.
• 2 Bryhn M, Persson S. Noninvasive findings in patients with hypertrophic and dilative cardiomyopathy: A combined echocardiographic and radionuclide angiographic study. Clin Cardiol 1986; 09: 533-43.
• 3 Carboneil LF, Salom MG, Garcia-Estan J. et al. Hemodynamic alterations in chronically conscious unrestrained diabetic rats. Am J Physiol 1987; 252: H900-5.
• 4 Crall FV, Roberts WC. The extramural and intramural coronary arteries in juvenile diabetes mellitus; analysis of nine necropsy patients aged 19 to 38 years with onset of diabetes before age 15 years. Am J Med 1987; 64: 221-30.
• 5 Dillman W. Influence of thyroid hormone administration on myosin ATPase activity and myosin isoenzyme distribution in the heart of diabetic rats. Metabolism 1982; 31: 199-204.
• 6 Ewing DJ, Campbell IW, Clarke B. Heart rate changes in diabetes mellitus. Lancet 1981; i: 183-5.
• 7 Fein FS, Kornstein LB, Strobeck JE. Altered myocardial mechanics in diabetic rats. Circ Res 1980; 47: 922-33.
• 8 Fisher BM, Gillen G, Lindop GBM. et al. Cardiac function and coronary arteriography in asymptomatic type I (insulin dependent) diabetic patients: evidence for a specific diabetic heart disease. Diabetologia 1986; 29: 706-12.
• 9 Fischer VW, Barner HB, Leskiw L. Capillary basal laminar thickness in diabetic human myocardium. Diabetes 1979; 28: 713-9.
• 10 Friedman NE, Levitsky LL, Edidin DV. Echocardiographic evidence for impaired myocardial performance in children with type I diabetes mellitus. Am J Med 1982; 73: 846-50.
• 11 Ganguly PK, Dhalle KS, Innes IA. Altered norepinephrine turnover and metabolism in diabetic cardiomyopathy. Circ Res 1966; 59: 684-93.
• 12 Hamby RI, Zoneraich S, Sharmen S. Diabetic cardiomyopathy. J Am Med Ass 1974; 229: 1749-54.
• 13 Hengliger CE, Prakash A, Me JHNeill. Alterations in cardiac sarcolemmal Ca + 2 pump activity during diabetes mellitus. Am J Physiol 1987; 252: H540-4.
• 14 Kahn JK, Zola B, Juni JE, Vinik AI. Radionuclide assessment of left ventricular diastolic filling in diabetes mellitus with and without cardiac autonomic neuropathy. J Am Coll Cardiol 1986; 07: 1303-9.
• 15 Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure. Am J Cardiol 1974; 34: 29-34.
• 16 Okada R, Shimuzu M, Sachio K. Histology of the conduction system in sudden cardiac death. Jpn Circ J 1983; 47: 373.
• 17 Onji T, Liu MS. Effects of alloxan diabetes in the sodium-potassium adenosine triphosphate enzyme system in dog hearts. Biochem Res Comm 1980; 96: 799-804.
• 18 Pauwels EKJ, Lemkes HHPJ, Gonsalves S. et al. Scintigraphic evidence of asymptomatic impaired left ventricular function in type I diabetics. Clin Nucl Med 1985; 10: 861-4.
• 19 Penpargkul S, Schiable T, Yipinstoi T. et al. The effect of diabetes on perfomance and metabolism of rat hearts. Circ Res 1980; 47: 911-21.
• 20 Pieper GM, Salhony JM, Murray WY. Lipid mediated impairment of normal energy metabolism in the isolated perfused diabetic rat heart studied by phosphorus-31 NMR and clinical extraction. Biochem Biophys Acta 1984; 803: 229-40.
• 21 Pierce GN, Kutryk MJB, Dhalla NS. Alterations in Ca + 2 binding by and composition of the cardiac sarcolemmal membrane in chronic diabetes. Proc Natl Acad Sei USA 1983; 80: 5412-6.
• 22 Regan TJ, Lyons MM, Ahmed SS. Evidence for cardiomyopathy in familiar diabetes mellitus. J Clin Invest 1977; 60: 885-99.
• 23 Shapiro LM, Leatherdale BA, Mackinnon J. et al. Left ventricular function in diabetes mellitus II: Relation between clinical features and left ventricular function. Br Heart J 1981; 45: 129-32.
• 24 Swedberg K. Congestive cardiomyopathy (dissertation). Gothenburg 1978; 39-52.
• 25 Throll H, Rabinovitch MA, Pitt B, Buda A. Cardiac dynamics. In: Textbook of nuclear medicine VII, Clinical applications. New York: Lea and Feabiger; 1984: 406-35.
• 26 Vered Z, Battler A, Segal P. Exercise- induced left ventricular dysfunction in young men with asymptomatic diabetes mellitus (diabetic cardiomyopathy). Am J Cardiol 1984; 54: 633-7.
• 27 Walker JM. Margouleff Cardiac scintigraphy. In: A clinical manual of nuclear medicine. Norwalk: Appleton-Century-Crofts; 1984: 51-65.