A Statistical Study on Left Ventricular Peak Filling Rate in Diabetes

 

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The importance of non-invasive evaluation of cardiac function in diabetes is well known and radionuclide angiocardiography has become an accepted diagnostic procedure. While the pathophysiological interpretation of systolic parameters is clear, the meaning and determinants of peak filling rate (PFR) remain rather speculative. In the present study, a “pattern recognition” approach, including principal component analysis and hierarchical cluster analysis, has been adopted in order to evaluate the determinants of PFR in a series of 48 non-selected diabetic patients. The results of the study show that: PFR is inversely dependent on age which is its main determinant when systolic function is preserved; PFR is inversely dependent on combined effects of left ventricular dimensions, angina and wall motion; and the duration of diabetes in itself does not influence PFR. These results lead to the following clinically relevant conclusions:

(a) It is unlikely that a young diabetic patient without anginal symptoms will have a significant PFR impairment even if the diabetes has been present for a long time. If such impairment is however present, ventricular latent dysfunction is likely to be the cause even if systolic parameters are still normal;

(b) A decrease of PFR in a middle-aged diabetic patient without symptoms and with normal systolic function cannot be equated with latent ventricular dysfunction as it may represent only an age-related physiological change without special diagnostic meaning.

Zusammenfassung

Die nichtinvasive Bewertung der Herzfunktion beim Diabetes ist wichtig, die Radionuklidangiokardiographie hat sich hierbei diagnostisch bewährt. Während die pathophysiologische Interpretation systolischer Parameter unstrittig ist, werden Bedeutung und Determinanten der “Peak Filling Rate (PFR)” eher spekulativ diskutiert. In der vorliegenden Untersuchung wurde mit Hilfe der Mustererkennung (inkl. prinzipale Komponenten- und hierarchische Klusteranalyse) versucht, die Determinanten der PFR bei 48 unselektierten diabetischen Patienten zu bestimmen. Die Ergebnisse zeigen, daß die PFR eine starke inverse Abhängigkeit vom Alter dann zeigt, wenn die systolische Funktion erhalten ist. Ferner zeigt die PFR eine inverse Abhängigkeit von der Kombination linksventrikuläre Größe, Wandbewegung und Angina pectoris-Anamnese. Die Dauer der Erkrankung beeinflußt die PFR nicht. Diese Ergebnisse führen zu folgenden klinisch relevanten Schlußfolgerungen: Es ist unwahrscheinlich, daß ein junger Diabetespatient ohne Angina pectoris eine PFR-Einschränkung aufweist, sogar wenn der Diabetes schon länger besteht. Wenn eine solche Einschränkung nachgewiesen werden kann, besteht ursächlich eine latente ventrikuläre Dysfunktion, auch wenn die systolischen Parameter noch normal sind. Ein Abfall der PFR beim Diabetiker im mittleren Alter ohne Symptome und mit normaler systolischer Funktion kann nicht gleichgesetzt werden mit einer latenten ventrikulären Dysfunktion, die nur eine altersbezogene physiologische Veränderung darstellt.

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