P181	Global diastolic function and myocardial perfusion are impaired by a similar extent in patients with type 2 diabetes mellitus and in patients with coronary artery disease.
1H.von Bibra, 2A.Hansen, 2V.Dounis, 2J.Jensen, 1P-M.Schumm-Draeger
1Academic Hospital Bogenhausen, München, DE; 2Karolinska Hospital, Stockholm, SE.

Objectives: Modern ultrasound technology was used to evaluate the extent of global LV diastolic dysfunction and myocardial perfusion abnormalities in patients with type 2 diabetes for comparison with individuals with coronary artery disease (CAD) to test the hypothesis, that the extent of global LV impairment is similar in both groups. Methods: This case-control study in 72 patients compared four age matched groups: Controls, diabetes, CAD and diabetes with CAD (DCAD). Patients were selected for LV ejection fraction > 50% and HbA1c < 7.8% and had 59±7 years mean age. By averaging data from 12 LV segments, global diastolic (Ve) and systolic myocardial velocities were assessed with tissue Doppler and global myocardial perfusion with contrast echocardiography as indices of capillary blood volume and myocardial blood flow at maximal vasodilatation (dipyridamole 0,84 mg/kg). Results: Comparing diabetes with controls, Ve was impaired (8.7±1.6 v 10.1±1.2 cm/s; p<0.02). Ve correlated inversely with age (p<0.01) and pulse pressure (p<0.04) which was increased (p<0.007). Capillary blood volume (16.6±5.0 v 24.4±4.9%) and blood flow (56±35 v 114±40) were decreased (p<0.001). These abnormalities were observed irrespective of the presence or absence of hypertension and also in the DCAD group. In CAD, Ve was similarly decreased (p<0.02) but associated with normal pulse pressure. CAD and DCAD patients had more cardiovascular preventive therapy (betablocker, statin and aspirin, p<0.02) associated with the same extent of impaired global perfusion (p<0.002) as the less treated diabetes group but superior perfusion of the nonculprit vascular territory compared to the less treated diabetes patients without CAD (p<0.05). Conclusion: Impairment of global diastolic function, myocardial capillary blood volume and blood flow by the same extent as in patients with CAD are hallmarks in patients with type 2 diabetes and deserve therapeutic concepts. Tissue Doppler and quantitative myocardial contrast echocardiography appear techniques with the potential for serial follow up.

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