Cardiomyopathy: Framingham Heart Study

The existence of cardiomyopathy was first proposed by Rubler et al, In 1974 Framingham study showed that heart failure was more common in diabetes due to diabetes cardiomyopathy.58,59 The Framingham heart study reveals a marked in congestive heart failure, coronary artery disease and myocardial infarction in diabetes patients.60

Diastole is that phase of the of the cardiac cycle when the heart is not contracting to propel blood out (systole) to the body, brain and lungs but instead is relaxing and filling with incoming blood that is being return from body through inferior vena cava from lungs through the pulmonary veins and the through superior vena cava. Diastole begins with aortic valve closure and ends with mitral valve closure. Diastole

Diastolic dysfunction has a major impact on symptoms status, functional capacity, medical treatment and prognosis in both systolic and diastolic heart failure (HF) irrespective of the cause.

Pathophysiology of LVDD:- Diastole is divided into four physiological phases:

1. Isovolumetric relaxation: from closure of the aortic valve to opening of

Left atrial enlargement with associated AF provides an easily identifiable indicator of LVDD and need for further echocardiography evaluation.

1- Trans mitral flow velocity: the early diastolic peak filling velocity when the transmitral pressure gradient is greatest generates the E wave velocity on the echocardiography. The late diastolic peak filling velocity associated with atrial contractions generates the A wave velocity. Because normal atrial contribution to total to total diastolic filling is only 30%, a normal A wave is smaller than E wave with a ratio >1. LVDD initially produces smaller E wave and a high with reversal of the E:A ratio. As disease progress the E wave increase until E/A ratio are >1.5. During the process of this transition, the E/A ratio will temporarly normalize despite the presence of moderately severe disease. This is referred to as pseudo-normalizations and highlights a limitation to sole use of E/A ratio for diagnosis.

2- Pulmonary venous flow (PVF): Atrial relaxation (x-descent) and LV diastole (y-descent) causes forward PVF. In LVDD, PVF reversal associated with atrial contraction becomes progressively more pronounced as LAP