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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although patients with diabetes mellitus may be afflicted by cardiomyopathy, its prevalence and nature are controversial. Studies have shown that fibrosis alters the acoustic properties of the heart in animals and humans and that the changes are detectable by cardiac tissue characterization with ultrasound. The present study was performed to characterize myocardial acoustic properties in patients with insulin-dependent diabetes to determine whether ultrasound tissue characterization could detect changes potentially indicative of occult cardiomyopathy. The magnitude of cyclic variation of myocardial ultrasound integrated backscatter and its phase delay with respect to the onset of the cardiac cycle in the septum and posterior wall of the left ventricle were measured in 54 patients with diabetes who had no overt cardiac disease. Conventional echocardiography documented normal ventricular systolic function in 96%. As compared with results in age-matched patients without diabetes studied previously, cyclic variation of integrated backscatter was reduced (4.6 +/- 0.8 vs. 3.6 +/- 1.4 dB; p less than 0.001). In addition, delay was significantly increased (0.86 +/- 0.09 vs. 0.99 +/- 0.15). The primary analysis of the data focused on differences among the diabetic patients. Reduction of cyclic variation of backscatter was greatest in patients with diabetes who had neuropathy (3.2 +/- 1.0 dB; p less than 0.001) as was the increase in delay (1.04 +/- 0.16, p less than 0.001 vs. values in patients without neuropathy). Retinopathy and nephropathy were associated with abnormal myocardial acoustic properties as well. Thus, abnormalities that may reflect fibrosis or other occult cardiomyopathic changes in diabetic patients without overt heart disease are readily detectable by myocardial tissue characterization with ultrasound and parallel the severity of noncardiac diabetic complications.
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PMID:Abnormal myocardial acoustic properties in diabetic patients and their correlation with the severity of disease. 156 16

Left ventricular function including regional wall motion (RWM) was evaluated by 99mTc first-pass and equilibrium gated blood pool ventriculography and glycohemoglobin (HbA1c) blood levels determined by a quantitative column technique in 25 young patients with insulin-dependent diabetes mellitus without clinical evidence of heart disease, and in healthy controls matched for age and sex. Phase analysis revealed abnormal RWM in 19 of 21 diabetic patients. The mean left ventricular global ejection fraction, the mean regional ejection fraction and the mean 1/3 filling fraction were lower and the time to peak ejection, the time to peak filling and the time to peak ejection/cardiac cycle were longer in diabetics than in controls. We found high HbA1c levels in all diabetics. There was no significant difference between patients with and without retinopathy and with and without peripheral neuropathy in terms of left ventricular function and HbA1c levels.
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PMID:Left ventricular dysfunction and blood glycohemoglobin levels in young diabetics. 180 Sep 43

We report a series of 33 consecutive hospitalized geriatric diabetic patients who were referred for evaluation of diabetic nephropathy, defined as proteinuria greater than or equal to 1 g/d (1,000 mg/24 h) or a serum creatinine concentration greater than or equal to 177 mumol/d (greater than or equal to 2 mg/dL). The study population was 60 years old or older (mean age, 68 +/- 6 years), was comprised mainly of women (24 of 33, 72.7%), and was predominantly black (25 of 33, 75.8%). All patients had type II diabetes. A family history of diabetes in parent or sibling was elicited in 24 (72.7%) patients. There were eight patients undergoing maintenance hemodialysis and 25 with less severe nephropathy (mean proteinuria, 2.7 g/d [2,700 mg/24 h]; mean creatinine clearance, 0.57 mL-s [34 mL/min]). Cardiac disorders were noted in the majority of patients: congestive failure in 20 (60.6%), myocardial infarction in eight (24.2%), and active angina in five (15.2%). Other comorbid diseases were present in both hemodialysis patients and the subset of nondialyzed azotemic-proteinuric patients, and consisted of peripheral neuropathy in 31 (93.9%), gastroparesis in 16 (48.5%), retinopathy in 28 (84.8%), and legal blindness in 11 (33%). We conclude that geriatric diabetic nephropathy in type II diabetes is similar in presentation and severity of comorbid extrarenal complications to the syndrome described in younger adults. This inference must be tempered by both the small size and the limitation imposed by the demographics of the study population, which is predominantly composed of black patients receiving treatment at inner city hospitals.
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PMID:Geriatric diabetic nephropathy: an analysis of renal referral in patients age 60 or older. 222 Jul 76

The Bardet-Biedl syndrome is a rare autosomal recessive disorder characterized by pigmentary retinopathy, obesity, polydactyly, hypogonadism, and mental retardation. Renal abnormalities, hypertension, acquired heart disease, and hepatic fibrosis also occur in homozygotes. Two adult Bardet-Biedl sibs, a man with hypertension and cardiomegaly and a woman with biliary cirrhosis, and 75 relatives in 5 generations of the extended family were identified. Hospital records for major illnesses, death certificates, and autopsy reports were examined. The frequent observation of obesity, hypertension, diabetes mellitus, and renal disease in first-degree relatives, obligate gene carriers, and other blood relatives raise the possibility that Bardet-Biedl heterozygotes are also predisposed to these disorders.
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PMID:Obesity, hypertension, and renal disease in relatives of Bardet-Biedl syndrome sibs. 187 34

The rate of birth abnormalities is 4-10 times higher in diabetic mothers than in the normal population. Mice embryos exposed to hyperglycemia increased developmental abnormalities (mostly before the 7th week of pregnancy) in linear fashion, while insulin treatment lowered them. The high level of glycosylated hemoglobin (HbAlC) during this period is associated with frequent abnormalities. In 116 diabetic women abnormal embryos were found in 22% of cases when HbAlC was 8.5%, while only 3% of the embryos were abnormal when HbAlC was 8.5%. Pregnant women whose diabetes was balanced from the 8th week of pregnancy had a 5.5% rate of abnormality compared to only .8% in those treated 3 months before pregnancy, and they also had fewer complications during pregnancy. The diabetic woman planning a pregnancy should have it earlier in life, get examined for nephropathy, retinopathy (treated by photocoagulation), hypertension, and ischemic heart disease. If these diseases are severe pregnancy is not advised. Before and during pregnancy sugar level must be checked 6-7 times a day and imbalance treated by insulin injections, or subdermal insulin pump in severe cases. Pregnancy is recommended only if the daily sugar balance is satisfactory, and the HbAlC value is less than 8%.
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PMID:[Pregnancy counseling in diabetic women]. 306 26

Indexes of left ventricular diastolic filling were measured by pulsed Doppler echocardiography in 21 insulin-dependent diabetic patients and 21 control subjects without clinical evidence of heart disease. No patient had chest pain or electrocardiographic changes during exercise testing. The mean age of patients was 32 years. All patients had a normal ejection fraction. Six (29%) of the 21 diabetic patients had evidence of diastolic dysfunction as assessed by the presence of at least two abnormal variables of mitral inflow velocity. The ratio of peak early to peak late (atrial) filling velocity was significantly decreased in diabetic compared with control subjects (1.24 +/- 0.21 versus 1.66 +/- 0.30, p. less than 0.001). Atrial filling velocity was significantly increased in diabetic patients (74.3 +/- 16.7 versus 60.3 +/- 12.2 cm/s, p less than 0.004), whereas early filling velocity was reduced by a nearly significant degree (88.8 +/- 12.6 versus 98.5 +/- 18.8 cm/s, p less than 0.057). The atrial contribution to stroke volume as assessed by area under the late diastolic filling envelope compared to total diastolic area was also significantly increased in diabetic compared with control subjects (35 versus 27%, p less than 0.001). Left ventricular diastolic filling abnormalities in diabetic patients did not correlate with duration of diabetes, retinopathy, nephropathy or peripheral neuropathy. These data suggest that approximately one-third of such patients have subclinical myocardial dysfunction unrelated to accelerated atherosclerosis. Doppler echocardiography may offer a reliable noninvasive means to assess diastolic function and to follow up diabetic patients serially for any deterioration in cardiac status before the appearance of clinical symptoms.
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PMID:Diastolic abnormalities in young asymptomatic diabetic patients assessed by pulsed Doppler echocardiography. 337 97

In order to investigate the relationship between haemorheological disturbances and diabetic microangiopathy we have studied the red blood cell deformability index (RBCD-index) by means of a filtration technique in 69 diabetics, aged 49-83 years, and in 40 non diabetic healthy controls (group A) of respective age and sex. The diabetics were classified into the following groups, according to the findings of a thorough clinical and laboratory investigation. Twenty patients (group B) were free of vascular complications, whereas 9 (group C) suffered from background retinopathy, 27 (group D) background retinopathy and ischaemic cardiopathy or peripheral arterial occlusive disease and 13 (group E) of proliferative retinopathy with diffuse micro- and macroangiopathy. The RBCD-index was significantly (P less than 0.001) decreased in diabetics with retinopathy compared to the diabetic and non diabetic controls. The lowest RBCD-index was observed in diabetics with proliferative retinopathy and in those with diffuse micro- and macrovascular complications (RBCD-index, means +/- SDM ml/min: A 0.68 +/- 0.15; B 0.64 +/- 0.08; C 0.60 +/- 0.08; D 0.49 +/- 0.09; E 0.48 +/- 0.09). These findings suggest that the RBCD is impaired in diabetics with retinopathy, especially in those with severe vascular complications, and that this abnormal rheological behavior of erythrocytes can be found even in the early stages of diabetic microangiopathy.
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PMID:Red blood cell deformability index in diabetic retinopathy. 342 73

49 diabetics (D) (26 IDD and 23 NIDD) were compared to 32 controls (C). Absence of ischemic cardiopathy (IC) was confirmed by routine investigations and noninvasive cardiovascular techniques, including an exercise ECG using 12 leads and a thallium 201 scintigraphy. Our results show: a) a prolonged mean isovolumetric relaxation time (IVRT) as studied by the M mode echocardiography and phonomechanography: D = 0,10 sec +/- 0,04; C = 0,05 sec +/- 0,02; p less than 0,0001; b) a reduced mean EF slope: D = 97,48 +/- 37,08 mm / sec; C = 125,68 +/- 34,35; p less than 0,005; c) a high mean Weissler index (ratio of PEP to LVET): D = 40 +/- 0,08; C = 33 +/- 0,05; p less than 0,01. IVRT and EF slope abnormalities are related to increased myocardial stiffness and impaired LV compliance. In the absence of changes in preload and afterload, the high Weissler index reflects impaired contractility of the myocardium. These abnormalities are related neither to the duration of diabetes nor to the presence or severity of the complications. With the M mode echocardiography, mean diastolic and systolic thickness of the septum is greater in D with retinopathy than in C (p less than 0,005 and p less than 0,03 respectively); mean diastolic and systolic thickness of the posterior wall is greater in NIDD than in C (p less than 0,001 and p less than 0,025). We conclude that there is evidence of left ventricular functional abnormalities specific to diabetes and unrelated to IC and hypertension. Our findings support the hypothesis that they may be due to metabolic disorders and/or myocardial microangiopathy.
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PMID:[Existence of asymptomatic changes in left ventricular function in the diabetic. Noninvasive study]. 400 44

Using digitized M-mode ecocardiography, 26 young subjects with type I diabetes mellitus of at least three years duration, without any clinical evidence of heart disease have been studied, searching for subclinical impairment of left ventricular function. Patients have been divided in two groups according to the presence (Group I, N degrees 7 patients) or absence (Group II, N degrees 19 patients) of retinopathy. The time interval from the shortest left ventricular diameter to the onset of mitral valve opening was significantly increased as compared with the control Group (10.20 +/- 8.88 control Group; 29.21 +/- 12.99 Group II, p less than 0.001; 41.00 +/- 12.29 Group I, p less than 0.001). Furthermore, a close correlation between the above named time interval and the duration of diabetes was found (r = 0.496, p less than 0.01). Finally, the change of left ventricular dimension during the time interval from the shortest left ventricular diameter to the onset of mitral valve opening, expressed as a percentage of left ventricular end-diastolic diameter, was increased (3.20 +/- 3.43 control Group; 8.21 +/- 5.51 Group II, p less than 0.02; 12.43 +/- 5.56 Group I, p less than 0.001). Our results suggest an impairment of ventricular relaxation due to increased wall stiffness. We conclude that there are often subclinical cardiac abnormalities in young diabetics resulting in impairment of diastolic function that is correlate with the duration of diabetes and with the presence of clinical complications such as retinopathy.
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PMID:[Altered diastolic function of the left ventricle in juvenile diabetes. Computerized echocardiographic study]. 652 99

We examined 178 men for the presence of diabetic retinopathy during 1978-80. They had been part of a group of 205 men from the Jerusalem area, diagnosed as being diabetic or having an abnormal glucose tolerance test in the Israel Ischaemic Heart Disease Project, a 5-year epidemiological investigation of Israeli male government employees. Seventy-four (42%) had diabetic retinopathy as determined by direct and indirect ophthalmoscopy, 3-mirror contact lens examination, and fundus photography. Those with and without retinopathy were compared for clinical, biochemical, behavioural, and biographical variables measured subsequently in 1963, 1965, and 1968. We found no significant differences between the 2 groups with respect to antecedent Quetelet index, blood pressure, peripheral vascular disease, blood lipids, haematocrits, smoking habits, area of birth, and education. Statistically significant differences between men with and without retinopathy were found for severity of carbohydrate metabolic intolerance at identification, duration of the metabolic abnormality, age, casual glucose values, and serum uric acid levels. Low serum uric acid appears to precede the incidence of diabetic retinopathy and to decline further as the disease progresses.
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PMID:Prevalence and 15-year incidence of retinopathy and associated characteristics in middle-aged and elderly diabetic men. 663 10


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