Assessment of cardiac function by Doppler echocardiography in patients with diabetic end-stage renal failure

response to the leg raising maneuver

Abstract

To determine why patients with diabetic end-stage renal failure tend to develop congestive heart failure, we investigated transmitral flow patterns using pulsed Doppler echocardiography before and during the passive leg raising maneuver (LRM).
The subjects consisted of 10 diabetic (DM) and 15 non-diabetic (nonDM) patients with chronic renal failure. Fifteen normal subjects served as controls (C). Peak early mitral flow velocity (E), peak atrial filling velocity (A), A/E and the deceleration half-time of E (DHT) were analyzed before and during LRM. A/E and DHT were significantly higher in DM and nonDM than in C. Transmitral flow patterns in DM were similar to those in nonDM before LRM. E was increased and DHT was decreased by LRM in all three groups. A was significantly increased by LRM in C and nonDM, but A was unchanged in DM.
Thus, in addition to the left ventricular diastolic dysfunction generally observed in both DM and nonDM patients left atrial dysfunction may become overt in DM as a result of LRM. This latent left atrial dysfunction may be one of the reasons patients with diabetic end-stage renal failure tend to develop congestive heart failure.