Effect of Type 2 Diabetes Mellitus on Left Ventricular Geometry and Systolic Function in Hypertensive Subjects

Palmieri, Vittorio; Bella, Jonathan N.; Arnett, Donna K.; Liu, Jennifer E.; Oberman, Albert; Schuck, Min Yan; Kitzman, Dalane W.; Hopkins, Paul N.; Morgan, David W.; Rao, D. C.; Devereux, Richard B.

doi:10.1161/01.cir.103.1.102

Cited by 309 publications

(222 citation statements)

References 57 publications

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“…29 In the Strong Heart Study, 27 which involved a wide group of American Indians, diabetic subjects had higher LVM, interventricular septum thickness, PWT and RWT in comparison with subjects without diabetes, with no difference in LV chamber size. Similar results were obtained in the HYperGEN Study, 28 in which diabetic hypertensives had higher LVM and more concentric geometry when compared with non-diabetic hypertensives (again in this study diabetics had higher LVM, interventricular septum thickness, PWT and RWT but there was no difference with regard to LV diameter). However, in this study the relation of diabetes with LVH lost statistical significance when duration of hypertension was included in the statistical analysis.…”

Section: Discussionsupporting

confidence: 88%

“…27,28 Moreover, diabetes has a negative impact on treatment-induced changes in LV structure and function in hypertensives with LVH. 29 In the Strong Heart Study, 27 which involved a wide group of American Indians, diabetic subjects had higher LVM, interventricular septum thickness, PWT and RWT in comparison with subjects without diabetes, with no difference in LV chamber size.…”

Section: Discussionmentioning

confidence: 99%

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Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

et al. 2010

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Left ventricular hypertrophy (LVH) and diastolic dysfunction are very common in patients with chronic kidney disease (CKD). Aim of this study was to evaluate the impact of type 2 diabetes on LV geometry and diastolic function in hypertensive patients with CKD. We enrolled 288 Caucasian subjects with hypertension and CKD; of them, 112 had diabetes. Patients with cardiovascular (CV) diseases, glomerular filtration rate (GFR) 460 ml min À1 per 1.73 m 2 , dialysis treatment and other major non-CV diseases were excluded. All patients underwent routine biochemical analyses and echocardiographic examination with tissue Doppler imaging (TDI). Patients with diabetes had significantly higher LV wall thicknesses (P ¼ 0.0001), relative wall thickness (RWT) (P ¼ 0.0001) and left atrium volume index (P ¼ 0.03), when compared with patients without diabetes. Further, diabetic patients had very high prevalence of concentric LVH. Em, evaluated by TDI, was significantly lower in patients with diabetes (P ¼ 0.005). However, the difference lost statistical significance after correction by analysis of covariance for RWT. Multiple stepwise linear regression analysis showed that the variables independently associated with Em were: age (b 0.364; P ¼ 0.0001), GFR (beta 0.101; P ¼ 0.019), and the presence of diabetes (b 0.166; P ¼ 0.002). Our study showed that in hypertensive patients with CKD the presence of diabetes is associated with increased LV-wall thicknesses and concentric geometry; further, diabetes together with renal function (GFR) is associated with worse diastolic function, independently of potential confounders, such as age, gender, body mass index and blood pressure.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

et al. 2010

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“…2,5,9 Non-insulin-dependent diabetes mellitus has been independently associated with an increase in left ventricular mass. 33,34 In our previous study among DHCCP patients, blood glucose concentration tended to be inversely related to the presence of ECG LVH by Sokolow-Lyon criterion. 35 In the Framingham Heart Study after adjusting for BMI and other risk factors, severity of hyperglycaemia was observed to be related to left ventricular mass more strongly in women than in men.…”

Section: Discussionmentioning

confidence: 80%

“…In the 1980s, although controlled prospective studies on the effectiveness and safety of treatment of SBP were lacking, the recommendations on antihypertensive treatment were based on DBP. 33 As most patients referred with hypertension between 1971 and 1986 presented with elevated DBP, this study clearly was biased towards diastolic hypertension. Long-term mortality data were obtained from death certificates, known for their potential inaccuracies.…”

Section: Strengths and Limitationsmentioning

confidence: 95%

Left ventricular hypertrophy determined by Sokolow–Lyon criteria: a different predictor in women than in men?

et al. 2006

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The clinical usefulness of the Sokolow-Lyon voltage criteria in the assessment of electrocardiographic left ventricular hypertrophy (ECG LVH) is addressed. We prospectively studied 3338 women and 3330 men referred with hypertension, with an average follow-up of 11.2 years. The voltage amplitude sum SV1 þ max (RV5 or RV6) was calculated and ECG LVH was defined as a sum X3.5 mV. We adjusted survival for age, treatment status before presentation and a previous myocardial infarction or cerebrovascular accident. The risk of stroke, coronary heart disease (CHD) and cardiovascular disease (CVD) mortality increased significantly for each quantitative 0.1 mV increase in baseline electrocardiogram (ECG) voltage, in women within the range of 1.6-3.9% and in men 1.4-3.0%. After further adjustments for race, body mass index, smoking and systolic blood pressure, increasing voltage independently predicted CVD mortality in both men and women. In women, both increasing voltage and the presence of left ventricular hypertrophy (LVH) were predictors of stroke mortality, whereas in men this risk was attenuated. In men, the adjusted association between increasing voltage and CHD mortality tended to be stronger than in women. The use of different thresholds for the two genders made little difference. For stroke and CHD mortality, the population attributable fractions associated with LVH were 15.2 and 5.4% in women and 12.8 and 8.5% in men, respectively. In conclusion, the greater the baseline ECG voltage sum, the greater the associated CVD mortality risk. Women tended to have a high risk of stroke mortality owing to LVH despite adjustments.

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“…All subjects were free from concomitant overt cardiovascular disease and diabetes mellitus, which may have an independent influence on LV mass and function. 21 We also excluded the potential confounding effect of current or previous antihypertensive treatment.…”

Section: Present Studymentioning

confidence: 99%

Left ventricular mass and systolic dysfunction in essential hypertension

et al. 2002

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A relation between left ventricular (LV) hypertrophy and depressed midwall systolic function has been described in hypertensive subjects. However, a strong confounding factor in this relation is concentric geometry, which is both a powerful determinant of depressed midwall systolic function and a correlate of LV mass in hypertension. To evaluate the independent contribution of LV mass to depressed systolic function, 1827 patients with never-treated essential hypertension (age 48 ؎ 12 years, men 58%) underwent M-mode echocardiography under two-dimensional guidance. Relative wall thickness was the strongest determinant of low midwall fractional shortening (r ‫؍‬ ؊0.63, P < 0.0001). The significant inverse relation observed between LV mass and midwall fractional shortening (r ‫؍‬ ؊0.43, P < 0.0001) persisted after taking into account the effect of relative wall thickness (partial r ‫؍‬ ؊0.27, P < 0.0001).

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Effect of Type 2 Diabetes Mellitus on Left Ventricular Geometry and Systolic Function in Hypertensive Subjects

Cited by 309 publications

References 57 publications

Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

Left ventricular hypertrophy determined by Sokolow–Lyon criteria: a different predictor in women than in men?

Left ventricular mass and systolic dysfunction in essential hypertension

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