The relationship between endothelial-dependent flow-mediated dilation and diastolic function in type 2 diabetes

• Published in: Acta diabetologica 2024-11, Vol.61 (11), p.1475-1482
• Main Authors: Cutruzzolà, Antonio, Parise, Martina, Cacia, Michele, Lucà, Stefania, Irace, Concetta, Gnasso, Agostino
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bioavailability; Blood Flow Velocity - physiology; Cardiomyopathy; Case-Control Studies; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Diabetic Cardiomyopathies - diagnostic imaging; Diabetic Cardiomyopathies - etiology; Diabetic Cardiomyopathies - physiopathology; Diastole - physiology; Echocardiography; Endothelium; Endothelium, Vascular - physiopathology; Female; Flow velocity; Heart; Humans; Hyperglycemia; Inflammation; Internal Medicine; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Nitric oxide; Original; Original Article; Oxidative stress; Vasodilation - physiology; Velocity; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left - physiology
• ISSN: 1432-5233; 0940-5429; 1432-5233
• DOI: 10.1007/s00592-024-02313-1

Aims Diastolic dysfunction represents the earliest and most common manifestation of diabetic cardiomyopathy. Nitric oxide (NO), a potent vasodilator and anti-inflammatory mediator released from the subendocardial and coronary endothelium, favors left ventricular distensibility and relaxation. In type 2 diabetes (T2D), the NO bioavailability is reduced due to the oxidative stress and inflammatory state of the endothelium, because of chronic hyperglycemia. The aim of the present research is to evaluate the relationship between endothelial function and diastolic function in subjects with T2D. Method Subjects with T2D and age and sex-matched healthy controls were consecutively recruited. All participants underwent flow-mediated dilation (FMD) to assess endothelial function, and echocardiography to evaluate diastolic function. Results Thirty-five patients (6 women, 29 men) and 35 healthy controls were included in the final analysis. FMD was significantly lower in T2D than controls (4.4 ± 3.4 vs. 8.5 ± 4.3%, p  = 0.001). T2D presented different abnormalities in diastolic function compared to controls: lower E/A (early to late diastolic transmitral flow velocity), lower septal and lateral e′ (early diastolic myocardial tissue velocity at septum and lateral wall), and higher E/e′ (surrogate of filling pressure). In subjects with T2D, we observed a significant correlation between FMD and E/e′ (r = −0.63, p  = 0.001), lateral e′ (r = 0.44, p  = 0.03), and septal e′ (r = 0.39, p  = 0.05). Conclusions Our observational study demonstrated a link between FMD and diastolic dysfunction in subjects with type 2 diabetes.