Global myocardial perfusion and diastolic function are impaired to a similar extent in patients with type 2 diabetes mellitus and in patients with coronary artery disease-evaluation by contrast echocardiography and pulsed tissue Doppler

Aims/hypothesis Using modern echocardiography, we quantified the extent of global myocardial function and perfusion abnormalities in patients with type 2 diabetes and compared this with the hypothetically similar extent of impairments in patients with coronary artery disease (CAD). Subjects and methods This case-control study (66 patients) compared four age-matched groups: control, type 2 diabetic, CAD, and diabetic subjects with CAD (DCAD) and left ventricular ejection fraction > 50%. CAD patients had 1-2 vessel disease. Diastolic and systolic myocardial velocities were assessed with pulsed tissue Doppler. Global myocardial perfusion was assessed with contrast echocardiography as indices of capillary blood volume and myocardial blood flow at maximal vasodilatation. In CAD and DCAD patients, functional and perfusion parameters were additionally assessed in the territory with a normal coronary angiogram reading, providing a model for comparison with the global data from control and diabetic patients. Results Comparing diabetic with control subjects, myocardial velocity at early diastole was impaired (8.8 +/- 1.8 vs 10.1 +/- 1.7 cm/s; p=0.02) and correlated inversely with age, HbA(1c) and pulse pressure (R-2=0.761). Capillary blood volume (16.6 +/- 5.0 vs 24.4 +/- 4.9%) and blood flow (56 +/- 35 vs 114 +/- 40) were decreased (p=0.001). In CAD patients, myocardial velocity at early diastole was similarly decreased (p=0.02). CAD and DCAD patients were receiving more cardiovascular preventive therapy for the same extent of impaired global perfusion as in the less extensively treated diabetes group without CAD (p < 0.002), but had superior perfusion of the 'normal' coronary territory than that group (p < 0.05). Conclusions/interpretation In patients with diabetes, global diastolic function and myocardial capillary blood volume and blood flow are impaired to the same extent as in patients with CAD. These impairments could form the basis of new therapeutic concepts.