Alterazione del riempimento ventricolare sinistro nei pazienti con diabete mellito insulino-dipendente e non insulino-dipendente

Diabetes mellitus can induce a pattern of myocardial pathology, known as specific diabetic cardiomyopathy even if this is not clearly specified. Aim of our study was to evaluate the presence of preclinical myocardial damage, by assessing with Doppler-echocardiography, 20 insulin-dependent (IDDM) diabetic patients, 10 non-insulin-dependent (NIDDM) diabetic patients and 12 healthy subjects (C) as controls, matched for age, gender and without overt cardiovascular disease. Systolic function parameters presented normal values in the three groups, with the exception of a slight reduction of ventricular volume indexes in NIDDM groups. Diastolic function was clearly impaired in both groups of patients versus healthy controls. Particularly, the ventricular filling was impaired in NIDDM versus IDDM patients, especially as well as protodiastolic peak filling rate E. Moreover in IDDM group, the duration of diabetes (p < 0.001) and the value of glycosilated hemoglobin (HbA(1c), p < 0.02) were higher than in NIDDM and C groups. With multiple regression analysis a significant inverse correlation was found between HbA(1c) and end diastolic peak filling rate A (R2 = 0.28) in both groups of patients and a direct correlation between VTI-E and age, duration of diabetes and HbA(1c) (R2 = 0.46). The two groups presented a homogeneous and reduced number of cases with an initial presence of microangiopathy and a borderline autonomic neuropathy, associated with microalbuminuria. Doppler echocardiography showed an early impairment of left ventricular filling, as well as a forward preclinical alteration of myocardial function in diabetic patients, especially in NIDDM group. These early signs of cardiomyopathy could constitute a predisposing condition towards the high cardiac morbidity and mortality in diabetic patients.