Abstract 2073: Use of Diastolic Tissue Velocity and Standard Parameters to Assess Treatment Response in Subclinical Myocardial Disease - A Randomized Trial of Lifestyle Intervention in Type 2 Diabetes
Background. Myocardial dysfunction is common in type 2 diabetes (T2DM), but the best markers of treatment response are undefined. We sought the effects of a 1 year lifestyle intervention (LI) on myocardial function and left ventricular (LV) characteristics, and to determine the predictors of this improvement.
Methods. Pts with uncomplicated T2DM (223), no known cardiac disease and a negative stress echo were randomized into usual care (n=112) or LI groups (n=111). The LI involved individualized home-based training (150min/wk of moderate exercise) and caloric restriction. Myocardial function (diastolic (E′) tissue velocity, strain and strain rate), LV characteristics (EF, E/A, LVMI and E/E′), metabolic control (HbA1c, blood glucose, insulin resistance (HOMA), BMI, fat mass) and VO2max were assessed at baseline and follow-up in 159 pts (LI n=74) who remained in the study for 1 year.
Results. Compared with usual care, LI was associated with significant (p<0.05) increases in E′ but not in strain, strain rate, EF, E/A, LVMI and E/E′ (Table⇓). Changes in E′ tissue velocity were significantly correlated with baseline E′ (r=−0.59, p<0.01), baseline metabolic status (BMI (r=0.23, p<0.01), insulin (r=0.22, p<0.01), HDL (r=−0.18, p<0.03)) and metabolic improvement (BMI (r=−0.17, p<0.04), insulin (r=−0.22, p<0.01), HbA1c (r=−0.24, p<0.01) and HOMA (r=−0.24, p<0.01)). Multivariate analysis revealed that age (beta=−0.33, p<0.01), baseline E′ (beta=−0.68, p<0.01) and changes in HbA1c (beta=−0.21, p<0.01) were independent predictors of changes in E′ and together accounted for 52% of the change in E′ (p<0.01).
Conclusions. Diastolic myocardial properties, but not systolic deformation or standard LV characteristics respond to a 1 year individualized lifestyle intervention in T2DM. Improved diastolic myocardial function were associated with poor metabolic and myocardial health at baseline and greater improvements in metabolism over the intervention period.