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Stress Echocardiography in Diabetes

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Stress Echocardiography

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Abstract

Diabetes mellitus can provoke cardiac damage at four levels: coronary macrovascular disease, cardiomyopathy with myocardial fibrosis causing systolic and diastolic dysfunction, coronary microvascular disease, and autonomic neuropathy. These syndromes are rarely found in isolated form in individual patients, but more often overlap and potentiate each other. In particular, diabetes mellitus induces coronary structural and functional microvascular abnormalities, which are associated with coronary endothelial dysfunction and impairment in coronary flow reserve, even in the absence of epicardial coronary artery disease. Regional wall motion abnormalities, B-lines, reduced left ventricular contractile reserve, abnormal coronary flow velocity reserve, and reduced heart rate reserve provide independent and incremental value in predicting outcomes in these patients. Exercise capacity is frequently impaired in people with diabetes due to the high prevalence of obesity, sedentary lifestyle, peripheral neuropathy (both sensory and motor), and vascular disease. For those unable to perform an exercise test, pharmacological stress testing with dipyridamole or dobutamine may be required. Comprehensive stress echocardiography is ideally suited to assess the different vulnerabilities of the diabetic heart allowing accurate phenoty** of the patient, refined risk stratification, and tailored intervention.

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Acknowledgments

The authors would like to acknowledge the contributions of Dr. Lauro Cortigiani for his contributions to the previous editions of this chapter.

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Authors and Affiliations

  1. Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Lodz, Poland

    Jaroslaw D. Kasprzak

  2. Institute of Clinical Physiology of the National Research Council, Pisa, Italy

    Eugenio Picano

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  1. Jaroslaw D. Kasprzak
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  1. Institute of Clinical Physiology of the National Research Council, Pisa, Italy

    Eugenio Picano

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Kasprzak, J.D., Picano, E. (2023). Stress Echocardiography in Diabetes. In: Picano, E. (eds) Stress Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-031-31062-1_29

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  • DOI: https://doi.org/10.1007/978-3-031-31062-1_29

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