Left ventricular function and specific diabetic complications in other target organs in young insulin-dependent diabetics: An echocardiographic study

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Abstract
Although the existence of “diabetic cardiopathy” is now undoubted, findings concerning the relationship between the clinical features of diabetes and left ventricular (LV) function are contradictory. The purpose of the present study was to investigate the influence of specific diabetic complications, consisting of retinopathy, nephropathy, and autonomic neuropathy, on LV function in a representative sample of 117 carefully selected young cardiac-asymptomatic type 1 (insulin-dependent) diabetics with duration of disease >2 years. As a control group, 54 healthy young subjects were studied. The diabetic complications were graded by a diabetic complication index (DCI). The diabetics were divided into three groups: those without complications (n = 46), those with mild complications (n = 39), and those with severe complications (n = 32). The LV function was assessed by M-mode echocardiography. A significant correlation between DCI and isovolumic relaxation time (r = 0.76), left atrium emptying index (r = −0.69), fractional shortening (r = −0.62), and ejection fraction (r = −0.60) was found. Diabetics with mild complications had diastolic abnormalities intermediate between those in patients free of complications and those with severe ones, but all their diastolic parameters were abnormal compared with control values. The systolic function in this mild complications group was normal. Diabetics with severe complications had the most pronounced diastolic dysfunction. All their systolic parameters were abnormal, indicating a contractile dysfunction. Most of them had dilated left atria and restricted left ventricles. Systolic dysfunction was found in 39% of the diabetics with complications and in 6% of those free of complications (x 2 = 15.5,P < 0.001). The frequency of diastolic dysfunction was 82% and 33%, respectively (x 2 = 28.6,P < 0.001). In conclusion, the present findings support the thesis that there is a strong relationship between LV function and diabetic complications in other target organs. The finding that more than half of the patients studied had LV systolic or diastolic dysfunction, even those with relatively low DCI, indicates that LV function abnormalities should be looked for as early as possible in cardiac-asymptomatic diabetics.

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