Does isometric handgrip exercise unmask left ventricular diastolic filling abnormalities in noninsulin-dependent diabetic patients with normal resting filling patterns?
Isometric handgrip exercise during Doppler echocardiography can unmask underlying left ventricular diastolic dysfunction in diabetic patients who have normal resting filling patterns.
Left ventricular diastolic filling properties during isometric handgrip exercise were measured by pulsed Doppler echocardiography in 33 noninsulin-dependent diabetic patients with a normal ejection fraction and 15 control subjects. Diabetic patients were subdivided into two groups according to their resting left ventricular filling pattern (A/E): 18 patients were in group DM-1 (A/E 1.1). At rest, A/E ratio and A wave were higher, and deceleration half-time was longer in group DM-2 than in normal subjects and group DM-1, but there was no significant difference between normal subjects and group DM-1. The A/E ratio increased significantly in all three groups during isometric handgrip exercise. However, the change in A/E from rest to peak exercise in group DM-1 (0.29 +/- 0.20) was significantly greater than in normal subjects (0.09 +/- 0.07). These results suggest that diabetes mellitus patients with normal resting left ventricular (LV) filling pattern (group DM-1) had LV diastolic filling abnormalities with isometric handgrip exercise. Doppler echocardiography with isometric handgrip exercise is useful in identifying underlying left ventricular diastolic dysfunction in diabetic patients.
Tarumi et al. (Tue,) studied this question.