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The Relationship of Cardiac Diastolic Dysfunction to Concurrent Hormonal and Metabolic Status in Type I Diabetes Mellitus^*

T. D. RUDDY, S. L. SHUMAK, P. P. LIU, A. BARNIE, S. J. SEAWRIGHT, P. R. MCLAUGHLIN^| and B. ZINMAN

Divisions of Endocrinology and Cardiology, Department of Medicine, Toronto General Hospital Toronto, Ontario, Canada

Address requests for reprints to: Bernard Zinman, M.D., 11 Eaton North, Room 229, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4.

The presence of diabetic cardiomyopathy and its relationship to concurrent hormonal and metabolic status have not been defined in patients with uncomplicated type I diabetes mellitus. Accordingly, radionuclide left ventricular angiograms and simultaneous metabolic profiles were obtained in 8 type I diabetic patients who had no major diabetic complications and in 11 normal subjects. Occult coronary artery disease was excluded by electrocardiogram exercise testing. Hemodynamics and systolic function did not differ between the groups. However, the peak filling rate (PFR; end-diastolic volumes per s) was less in the diabetic patients at rest [mean, 4.1 ± 0.2 (± SE) vs. 4.8 ± 0.2; P < 0.05] and during aerobic (6.8 ± 0.2 vs. 8.0 ± 0.3; P < 0.01) and anaerobic exercise (8.8 ± 0.3 vs. 9.8 ± 0.4; P < 0.05). The time to PFR was prolonged in the diabetic patients at rest (174 ± 10 vs. 133 ± 7 ms; P < 0.01) and during anaerobic exercise (126 ± 5 us. 103 ± 6 ms; P < 0.01). Plasma glucose and insulin levels were elevated in the diabetic patients at rest and during exercise. Otherwise, the metabolic and hormonal levels did not differ between the groups. In the diabetic patients, no single metabolic or hormonal parameter correlated with PFR or time to PFR. Impairment of diastolic filling also did not correlate with level of glycosylated hemoglobin or duration of diabetes. The alteration in diastolic filling present in type I diabetic patients who have no other diabetic complications may represent the earliest functional effect of diabetic cardiomyopathy.

^* This work was supported in part by Grant Tl-7 from the Heart and Stroke Foundation of Ontario.

t Research Fellow of the Medical Research Council of Canada.

t Connaught-Novo Fellow of the Canadian Diabetes Association.

Senior Research Fellow of the Heart and Stroke Foundation of Ontario.

^| Research Associate of the Heart and Stroke Foundation of Ontario.

Received May 13, 1987.

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