Objective: The aim of the study was to evaluate left ventricular diastolic function and its relation to aortic wall stiffness in patients with type 1 diabetes mellitus without coronary artery disease or hypertension. Patients: Sixty-six patients with type 1 diabetes mellitus were examined by echocardiography and divided into two groups according to the diastolic filling pattern determined by mitral annulus tissue Doppler velocities. Group A patients (n = 21) presented diastolic dysfunction with a peak early diastolic mitral annular velocity (Em)/peak late diastolic mitral annular velocity (Am) ratio <1 whereas in group B patients (n = 45) the Em/Am ratio was >1. Coronary artery disease was excluded based on normal thallium scintigraphy. Aortic stiffness index was calculated from aortic diameters measured by echocardiography, using accepted criteria. Results: Aortic stiffness index differed significantly among the two groups. Significant correlations were found between parameters of left ventricular diastolic function (Em/Am, isovolumic relaxation time, deceleration time) and aortic stiffness index. Multiple stepwise linear regression analysis revealed aortic stiffness index (β = –0.39, p = 0.001) and isovolumic relaxation time (β = –0.46, p < 0.001) as the main predictors of Em/Am ratio. Conclusions: Aortic stiffness is increased in type 1 diabetic patients with left ventricular diastolic dysfunction. This impairment in aortic elastic properties seems to be related to parameters of diastolic function.

1.
Giannattasio C, Failla M, Piperno A, et al: Early impairment of large artery structure and function in type I diabetes mellitus. Diabetologia 1999;42:987–994.
2.
Belz GG: Elastic properties and Windkessel function of the human aorta. Cardiovasc Drugs Ther 1995;9:73–83.
3.
Stefanadis C, Stratos C, Boudoulas H, Kourouklis C, Toutouzas P: Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with coronary artery disease. Eur Heart J 1990;11:990–996.
4.
Dokainish H: Tissue Doppler imaging in the evaluation of left ventricular diastolic function. Curr Opin Cardiol 2004;19:437–441.
5.
Oxlund H, Rasmussen LM, Andreassen TT, et al: Increased aortic stiffness in patients with type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1989;32:748–752.
6.
Fraser GE, Luke R, Thompson S, Smith H, Carter S, Sharpe N: Comparison of echocardiographic variables between type I diabetics and normal controls. Am J Cardiol 1995;75:141–145.
7.
Schannwell CM, Schneppenheim M, Perings S, Plehn G, Strauer BE: Left ventricular diastolic dysfunction as an early manifestation of diabetic cardiomyopathy. Cardiology 2002;98:33–39.
8.
Eren M, Gorgulu S, Uslu N, Celik S, Dagdeviren B, Tezel T: Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension, diabetes, or both. Heart 2004;90:37–43.
9.
Mottram PM, Haluska BA, Leano R, Carlier S, Case C, Marwick TW: Relation of arterial stiffness to diastolic dysfunction in hypertensive disease. Heart 2005;91:1551–1556.
10.
Basta G, Schmidt AM, De Caterina R: Advanced glycation end products and vascular inflammation: implications for accelerated atherosclerosis in diabetes. Cardiovasc Res 2004;63:582–592.
11.
Rasmussen LM, Ledet T: Aortic collagen alterations in human diabetes mellitus. Changes in basement membrane collagen content and in the susceptibility of total collagen to cyanogen bromide solubilisation. Diabetologia 1993;36:445–453.
12.
Johnstone MT, Creager SJ, Scales KM, Cusco JA, Lee BK, Creager MA: Impaired endothelium-dependent vasodilation in patients with insulin-dependent diabetes mellitus. Circulation 1993;88:2510–2516.
13.
London GM, Marchais SJ, Guerin AP, Pannier B: Arterial stiffness: pathophysiology and clinical impact. Clin Exp Hypertens 2004;26:689–699.
14.
Fang ZY, Prins JB, Marwick TH: Diabetic cardiomyopathy: evidence, mechanisms and therapeutic implications. Endocr Rev 2004;25:543–567.
15.
Asmar R, Benetos A, Topouchian J, et al: Assessment of arterial distensibility by automatic pulse wave velocity measurement: validation and clinical application studies. Hypertension 1995;26:485–490.
16.
Bia D, Aguirre I, Zocalo Y, Devera L, Cabrera Fischer E, Armentano R: Regional differences in viscosity, elasticity and wall buffering function in systemic arteries: pulse wave analysis of the arterial pressure-diameter relationship. Rev Esp Cardiol 2005;58:167–174.
17.
Lehmann ED: Noninvasive measurements of aortic stiffness: methodological considerations. Pathol Biol 1999;47:716–730.
18.
Shotwell M, Singh BM, Fortman C, Bauman BD, Lukes J, Gerson MC: Improved coronary disease detection with quantitative attenuation-corrected Tl-201 images. J Nucl Cardiol 2002;9:52–62.
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