Key result
Moderate-to-severe LV diastolic dysfunction in type 2 diabetes is linked to ~2-point lower NMD.
Why the study?
Diabetes mellitus is a risk factor for left ventricle diastolic dysfunction, but whether endothelial and/or autonomic dysfunction are associated with this dysfunction remains to be investigated.
Is left ventricular diastolic dysfunction associated with endothelial or cardiac autonomic dysfunction in patients with type 2 diabetes mellitus?
Cross-Sectional (n=84)
No
Is left ventricular diastolic dysfunction associated with endothelial or cardiac autonomic dysfunction in patients with type 2 diabetes mellitus?
In patients with type 2 diabetes mellitus, early left ventricular diastolic dysfunction is associated with subclinical endothelium-independent vascular dysfunction, shedding light on HFpEF pathophysiology.
Answers are grounded in this paper and cite their sources.
Supports vascular role in diabetic diastolic dysfunction; hypothesis-generating for HFpEF mechanisms and needs longitudinal confirmation.
BACKGROUND AND AIMS: Diabetes mellitus (DM) is a risk factor for left ventricle (LV) diastolic dysfunction. Aim of this study was to investigate whether endothelial and/or autonomic dysfunction are associated with LV diastolic dysfunction in DM patients. METHODS: We studied 84 non-insulin-dependent type 2 DM (T2DM) patients with no heart disease by assessing: 1) LV diastolic function by echocardiography; 2) peripheral vasodilator function, by measuring flow-mediated dilation (FMD) and nitrate-mediate dilation (NMD); 3) heart rate variability (HRV) on 24-h Holter electrocardiographic monitoring. RESULTS: Twenty-five patients (29.8%) had normal LV diastolic function, while 47 (55.9%) and 12 (14.3%) showed a mild and moderate/severe diastolic dysfunction, respectively. FMD in these 3 groups was 5.25 ± 2.0, 4.95 ± 1.6 and 4.43 ± 1.8% (p = 0.42), whereas NMD was 10.8 ± 2.3, 8.98 ± 3.0 and 8.82 ± 3.2%, respectively (p = 0.02). HRV variables did not differ among groups. However, the triangular index tended to be lower in patients with moderate/severe diastolic dysfunction (p = 0.09) and a significant correlation was found between the E/e' ratio and both the triangular index (r = -0.26; p = 0.022) and LF amplitude (r = -0.29; p = 0.011). CONCLUSIONS: In T2DM patients an impairment of endothelium-independent, but not endothelium-dependent, dilatation seems associated with LV diastolic dysfunction. The possible role of cardiac autonomic dysfunction in diastolic dysfunction deserves investigation in larger populations of patients.
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Tremamunno et al. (2021) conducted a cross-sectional in Type 2 Diabetes Mellitus (n=84). Left ventricular diastolic dysfunction vs. Normal left ventricular diastolic function was evaluated on Nitrate-mediated dilation (NMD) (p=0.02). In patients with type 2 diabetes, moderate-to-severe left ventricular diastolic dysfunction was associated with significantly reduced endothelium-independent vasodilation (NMD 8.82% vs 10.8%, p=0.02) compared to those with normal diastolic function.
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