PMID- 21195376
OWN - NLM
STAT- MEDLINE
DCOM- 20110408
LR  - 20161125
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 107
IP  - 4
DP  - 2011 Feb 15
TI  - Usefulness of at rest and exercise hemodynamics to detect subclinical myocardial 
      disease in type 2 diabetes mellitus.
PG  - 615-21
LID - 10.1016/j.amjcard.2010.10.024 [doi]
AB  - Patients with type 2 diabetes mellitus (T2DM) might have subclinical myocardial 
      dysfunction identified at rest or unmasked during exercise. We examined the 
      correlates of the myocardial exercise response in patients with T2DM. Myocardial 
      dysfunction was sought during at rest and exercise echocardiography in 167 
      healthy patients with T2DM (97 men, 55 +/- 10 years). Myocardial ischemia was 
      excluded using stress echocardiography. Standard echocardiography and color 
      tissue Doppler imaging measures (early diastolic tissue velocity [Em], strain, 
      and strain rate) were acquired at baseline and peak stress. The calibrated 
      integrated backscatter was calculated from the at rest parasternal long-axis 
      view. The longitudinal diastolic functional reserve index after exercise was 
      defined as DeltaEm [1 - (1/Em(base))]. The clinical, anthropometric, and metabolic 
      data were collected at rest and stress. Subclinical myocardial dysfunction at 
      baseline (n = 24) was independently associated with weight (odds ratio [OR] 1.02, 
      p = 0.04) and hemoglobin A1c (OR 1.36, p = 0.03). This group displayed an 
      impaired exercise response that was independently associated with a reduced 
      exercise capacity (OR 0.84, p = 0.034) and longitudinal diastolic functional 
      reserve index (OR 0.69, p = 0.001). Inducible myocardial dysfunction (stress Em 
      <-9.9 cm/s) was identified after exercise in 70 of the remaining 143 subjects. 
      This finding was associated with calibrated integrated backscatter (OR 1.08, p = 
      0.04) and lower peak heart rate (OR 0.97, p = 0.002) but not metabolic control. 
      The intensity of the metabolic derangement in patients with T2DM was associated 
      with subclinical at rest myocardial dysfunction, but not with the myocardial 
      exercise response. In conclusion, the association of an abnormal stress response 
      with nonmetabolic factors, including backscatter and blunted peak heart rate, 
      suggests potential roles for myocardial fibrosis and cardiac autonomic neuropathy 
      in patients with nonischemic diabetic heart disease.
CI  - Copyright (c) 2011 Elsevier Inc. All rights reserved.
FAU - Jellis, Christine L
AU  - Jellis CL
AD  - The University of Queensland, Brisbane, Australia.
FAU - Stanton, Tony
AU  - Stanton T
FAU - Leano, Rodel
AU  - Leano R
FAU - Martin, Jennifer
AU  - Martin J
FAU - Marwick, Thomas H
AU  - Marwick TH
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20101231
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
SB  - IM
MH  - Aged
MH  - Algorithms
MH  - Cardiomyopathies/*complications/diagnostic imaging/*physiopathology
MH  - Diabetes Complications/diagnostic imaging/*physiopathology
MH  - Diabetes Mellitus, Type 2/*complications/diagnostic imaging/*physiopathology
MH  - Diagnosis, Differential
MH  - Echocardiography, Stress
MH  - *Exercise Test
MH  - Female
MH  - *Hemodynamics
MH  - Humans
MH  - Male
MH  - Medical Records
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - *Rest
MH  - Risk Assessment
MH  - Risk Factors
MH  - Sensitivity and Specificity
EDAT- 2011/01/05 06:00
MHDA- 2011/04/09 06:00
CRDT- 2011/01/04 06:00
PHST- 2010/09/25 00:00 [received]
PHST- 2010/10/05 00:00 [revised]
PHST- 2010/10/05 00:00 [accepted]
PHST- 2011/01/04 06:00 [entrez]
PHST- 2011/01/05 06:00 [pubmed]
PHST- 2011/04/09 06:00 [medline]
AID - S0002-9149(10)02107-7 [pii]
AID - 10.1016/j.amjcard.2010.10.024 [doi]
PST - ppublish
SO  - Am J Cardiol. 2011 Feb 15;107(4):615-21. doi: 10.1016/j.amjcard.2010.10.024. Epub 
      2010 Dec 31.