Tariq Mahmood Alam, Masoud Alam, SAA Najmi.
Preclinical diastolic dysfunction in non-insulin-dependent diabetes mellitus (NIDDM).
Pak J Pathol Jan ;7(2):4-9.

The metabolic changes in non-insulin-dependent diabetes mellitus (NIDDM) predispose to a cluster of abnormalities. Diabetic cardiomyopathy is an important factor responsible for most of the adverse cardiac outcomes. This study was designed with an anticipation that cardiomyopathy sets in at a very early stage in NIDDM which distorts the diastolic function of heart in apparently healthy patients. The diastolic performance was noninvasively evaluated in 20 male patients having NIDDM of short duration (3.2+/-1.69 years) and without clinically overt cardiovascular disease. They were compared with healthy subjects (n=20) matched for age and body mass index. The diastolic variables included rapid relaxation period (A20 interval), the duration of rapid filling wave (RFW) and a/H ratio. These were derived from concurrently recorded apexcardiogram, phonocardiogram and ECG. There was no significant difference in A20 interval and RFW of the two groups. However the a/H ratio was markedly increased in NIDDM patients in contrast with the normal subjects (5.7+/1.06 vs 2.1 +/- 0.73%; p <0.0001). The increased a/H ratio reflects reduced ventricular compliance which may be due to early infiltrative changes in myocardial interstitium. These results clearly indicate the existance of cardiomyopathy in its preclinical stage in recently diagnosed NIDDM patients. It produces diastolic dysfunction independent of coronary heart disease and hypertension.

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