Assessment of arterio-ventricular coupling by tissue Doppler and wave intensity in type 2 diabetes

Abstract

Aim To evaluate ventricular-arterial coupling in preclinical cardiovascular disease, we used a new wave intensity approach and tissue Doppler in patients with and without type 2 diabetes mellitus (DM). Methods Sixty-five type 2 diabetes patients and 57 control individuals with normal systolic left ventricular function and without overt coronary or peripheral artery disease were assessed by tissue Doppler for myocardial velocities and by a combined Doppler and echo-tracking system (Aloka SSD-5500, Tokyo) for local arterial stiffness (epsilon, pulse wave velocity) and the characteristic peaks W1 and W2 of pulse wave intensity. Results Diabetes patients had significantly higher systolic blood pressure and pressure derivates (p<0.002). Diastolic myocardial velocity (Ve) was decreased (p<0.001). Epsilon and pulse wave velocity (p<0.001) were higher and so was W1 (11785±7491 vs. 9191±4299, p<0.04) but not W2. In the pooled data, independent predictors for Ve were age, septal wall thickness, Vs and HbA1C (R2 duration of diabetes (R2 0.479). 0.426) and for W1 systolic blood pressure, Vs, W2 and duration of diabetes (R2 0.479). Conclusion In type 2 diabetes pump function is preserved and maintained against increased arterial stiffness and impedance at the expense of increased myocardial oxygen requirements. Tissue Doppler and wave intensity measurements may be useful for therapeutic monitoring.