Study On Changes Of Cardiac Function In Patients With Early Diabetes Mellitus Heart Disease By Echocardiography

BackgroundWith the development of living standard,the morbidity of Diabetes mellitus is increasing.Diabetes mellitus is a kind of metabolic disorder which caused by lacking insulin and or disturbance of biological effect of insulin.Diabetes Mellitus could also be complicated chronic lesion in multiple organs consisting of Diabetic Mellitus retinopathy,diabetic nephropathy,autonomic neuropathy and angiocardiopathy. Angiocardiopathy is one of the common complications and main reason of dead as well.Compared with nondiabetie,Diabetes Mellitus are liability to silent myocardial ischemia.Moreover,Diabetes Mellitus were much younger, higher mortality rate and worse prognosis.Diabetes Mellitus could also lead to congestive cardiac failure and increasing incidence rate of congestive cardiac failure caused by other diseases.Diabetic cardiomyopathy may be the main reasons of being liability to cardiac failure and bad prognosis.A number of animal experimental,pathologic and epidemiology studies support the existence of diabetic cardiomyopathy.At present,however,there are still lack of effective criteria to diagnose diabetes cardiomyopathy,which can be only be considered when the other known cardiac diseases have been excluded.The clinical diagnosis of diabetic cardiomyopathy is made when systolic and diastolic left ventricular dysfunctions are present in diabetic patients without other known cardiac disease.In fact,treatment to reverse this disorder is more likely to effective before it goes to the point of dilated cardiomyopathy,detecting diabetic cardiomyopathy at an early stage is very important.Objective Diabetes mellitus and control subjects were examined by echocardiography in present studies,in order to assess the clinic value of echocardiography in early diagnose Diabetes Mellitus heart disease.Material and MethodsThirty-nine patients as Group A,sixteen male and twenty -three female, aged from forty to fifty-nine(mean age 52.3±6.3) with insulin-independent diabetes mellitus without evidences of heart diseases were recruited from the out-patient and ward Department of Endocrinology from January to August in 2006 and examined by echocardiography.There were asymptomatic cardiac disease and laboratory examination,artery hypertension, Electrocardiogram and treadmill test were normal in all patients.Patients in Group B were the same ones after half year treatment.Thirty-five healthy subjects as Group C,twenty male and fifteen female,aged from forty-two to fifty-eight(mean age 48.6±7.1),were selected from health examination from January to April in 2006.Left ventricular end diastolic diameter,thicknesses of inter-ventricular,posterior left ventricular wall and left atrium diameter were measured,and shortening fraction and ejection were calculated by two-dimensional and M-mode echocardiography.The pulse Dopple echocardiography was used to measure and analyses the pulmonary venous spectrum,trans-mitral spectrum and aortic spectrum.Tei index was calculated individually.Values were expressed as mean±standard deiviation.Independentsamples t test was used to compare the difference between different group.A p value of＜0.05 was considered statistically significant.Results1,Compared patients with diabetes mellitus before and after treatment with control,no significance were found in age,gender and systolic pressure (P＞0.05),however,body mass index,diastolic pressure and glucose in cases were higher than those in control(p＜0.01,p＜0.05,and p＜0.01 individually).No significances were existed again after treatment between diastolic pressure and body mass index.After treatment, moreover,serum glucose decreased as well.2,Compared with control,the left atrium diameter,end diastolic diameter of left ventricular,thicknesses of inter-ventricular and posterior left ventricular wall,and left ventricular mass index showed higher in Diabetes Mellitus(P＜0.05),but no significance in ejection fraction and shortening fraction(P＞0.05).No statistic difference were found in ejection fraction and shortening fraction between DM and control(P＞0.05)3,The peak early diastolic velocity of mitrial inflow was decreased in DM although without statistic difference(P＞0.05).The peak late diastolic velocities of mitrial inflow in DM before and after treatment were higher than that in control(P＜0.05).Ep/Ap ratio exceeded one in DM,the value was lower than that in control(P＜0.01).The value of Ep/Ap ratio increased after treatment,however,no statistic difference existed(P＞0.05)Tei index in DM was bigger than that in control(P＜0.01).Tei index in group B was shorter than that in group A and bigger than that in control(P＜0.05).The velocity of pulmonary venous antidrom-velocity was higher in DM than that in control(P＜0.01).There were tendencies that peak diastolic velocity of pulmonary vein was lower in case but peak systolic velocity of pulmonary vein was higher than those in case.Conclusion1,The structure abnormal could be found out by two-dimensional and M-mode echocardiography although lack of evidence of cardiac changes.The major changes represent as the augmentation of left ventricular mass index and left atrium.2,It is not easy to find out the abnormality of left diastolic function if only analyze the peak early diastolic velocity of mitrial inflow(Ep), the peak late diastolic velocity of mitrial inflow(Ap) and Ep/Ap ratio. 3,The spectrum of pulmonary venous antidrom-velocity could assess the left ventricular diastolic impairment much easier.It is easy to find abnormality via detecting pulmonary vein rather than via detecting spectrum of trans-mitrial velocity.4,Tei index which were calculated by measured isovolumic relaxation time,isovolumetric contraction time,and left ventricular ejection time via mitral and aortic inflow could synthetically evaluate cardiac function.Tei index provides a sate,reliable and non invasive new method to detect the changes of early Diabetes Mellitus cardiac function sensitively and quantitatively.5,The left ventricular diastolic functional impairment in patients with Diabetes Mellitus could be assessed via analyze the spectrum of pulmonary venous antidrom-velocity and Tel index.Due to normal systolic function at that time,systolic functional impairment appeared after diastolic functional impairment could be concluded in Diabetes Mellitus.6,Echocardiography is a non-invasive and repeatable method.The earlier detect the left ventricular diastolic function for Diabetes Mellitus by echocardiography,the better to find out diastolic dysfunction. Therapy aimed to Diabetes Mellitus systematically and to improve left ventricular diastolic function simultaneously could slow down the occurrence of heart failure and cut down the mortality in patients with Diabetes Mellitus.