MYOCARDIAL DYSFUNCTION WITHOUT CORONARY-ARTERY DISEASE IN DIABETIC RENAL-FAILURE

Fifteen patients with diabetes of juvenile onset and azotemic nephropathy were found to have no evidence of significant coronary artery disease after cardiac catheterization, coronary angiography and ventriculography. Three groups were delineated in terms of myocardial function. There were no differences among the groups in age, sex distribution, duration of diabetes, hypertension or azotemia, presence of surgical arteriovenous fistula or blood concentrations of hemoglobin, cholesterol, urea nitrogen, creatinine or uric acid. Some evidence of myocardial dysfunction was found in eight patients (59 percent)-four with diffuse myocardial dysfunction and four with elevation of left ventricular end-diastolic pressure alone. The hypothesis of a diabetic cardiomyopathy is discussed in terms of a spectrum that may include patients with pressure-volume abnormalities alone; patients with increased left ventricular end-diastolic pressure and an abnormal pressure-volume curve; and patients with a diffusely abnormal ventriculogram, decreased ejection fraction, increased left ventricular end-diastolic pressure and an abnormal pressure-volume curve. © 1979.