Clinical Science (2003) 105, 591–599 (Printed in Great Britain) 591 Subclinical left ventricular dysfunction in asymptomatic patients with Type II diabetes mellitus, related to serum lipids and glycated haemoglobin Dragos VINEREANU * , Eleftherios NICOLAIDES * , Ann C. TWEDDEL * , Christoph F. M ¨ ADLER * , Ben HOLST * , Lucy E. BODEN * , Mircea CINTEZA†, Alan E. REES * and Alan G. FRASER * ∗ Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, U.K., and †University Hospital of Bucharest, Str. Splaiul Independentei 169, Bucharest, Romania A B S T R A C T The aim of the present study was to measure regional ventricular function at rest and during stress in order to assess if patients with Type II diabetes have subclinical myocardial dysfunction and if it is related to risk factors. Seventy subjects (35 patients with Type II diabetes with no symptoms, signs or history of heart disease, and 35 age- and sex-matched healthy controls) had echocardiography at rest and during dobutamine stress. Myocardial velocities were measured off-line from digital loops of colour tissue Doppler. Subendocardial function was assessed from the mean longitudinal velocities of four basal segments (apical views) and radial function from the velocities of the basal posterior wall (parasternal view). Systolic functional reserve was calculated as the increase in velocity from baseline. Longitudinal peak systolic velocity was lower in patients with diabetes, at rest (5.6 + − 1.4 compared with 6.5 + − 1.1 cm/s) and at peak stress (10.9 + − 2.8 compared with 14.3 + − 2.1 cm/s) (both P < 0.01). Functional reserve was impaired in patients with diabetes ( + 5.4 + − 2.0 compared with + 7.7 + − 1.7 cm/s; P < 0.01). Radial systolic velocity was higher in patients with diabetes (5.4 + − 1.3 compared with 4.7 + − 1.4 cm/s; P < 0.05). Resting longitudinal systolic function correlated inversely with low-density lipoprotein–cholesterol (r =− 0.53), glycated haemoglobin (r =− 0.48), age (r =− 0.41) and diastolic blood pressure (r =− 0.38) (all P < 0.05). Peak stress systolic velocity correlated inversely with glycated haemoglobin (r =− 0.46) and age (r =− 0.44) (both P < 0.01). In conclusion, patients with Type II diabetes and no clinical heart disease have impaired subendocardial function of the left ventricle at rest and peak stress, which is related to glycated haemoglobin and serum low-density lipoprotein–cholesterol. INTRODUCTION Diabetes is a risk factor in 10–30% of patients who develop heart failure [1]. In Type II diabetes, isolated abnormalities of diastolic relaxation in the absence of Key words: diabetes mellitus, stress echocardiography, tissue Doppler, ventricular function. Abbreviations: A, peak atrial velocity; A TDE , velocity of mycardial motion during systole; CV, coefficient of variation; E, peak early velocity; E a , peak diastolic velocity during mitral annular motion during early filling; E TDE , early diastolic velocity of myocardial motion; HbA 1c , glycated haemoglobin; LV, left ventriclular; LDL, low-density lipoprotein; PSV, peak systolic velocity; TDE, tissue Doppler echocardiography. Correspondence: Dr Alan G. Fraser (e-mail fraserag@cf.ac.uk). symptoms or signs of heart disease suggest a diagnosis of ‘diabetic cardiomyopathy’. This is thought to result from microangiopathy, deposition of collagen, decreased expression/activation of the K + channel and Na + pump and decreased myofilament Ca 2 + sensitivity [2–4]. C  2003 The Biochemical Society