Impact of Diabetes on Cardiac Function in Patients with High Blood Pressure

Abstract

Background: Although the combination of high blood pressure (HBP) and type 2 diabetes (T2DM) increases the risk of left ventricular (LV) dysfunction, the impact of T2DM on LV geometry and subclinical dysfunction in hypertensive patients and normal ejection fraction (EF) has been infrequently evaluated. Methods: Hypertensive patients with or without T2DM underwent cardiac echocardiography coupled with LV global longitudinal strain (GLS) assessment. Results: Among 200 patients with HBP (mean age 61.7 ± 9.7 years) and EF > 55%, 93 had associated T2DM. Patients with T2DM had a higher body mass index (29.9 ± 5.1 kg/m2 vs. 29.3 ± 4.7 kg/m2, p = 0.025), higher BP levels (158 ± 23/95 ± 13 vs. 142 ± 33/87 ± 12 mmHg, p = 0.003), a higher LV mass index (115.8 ± 32.4 vs. 112.0 ± 24.7 g/m2, p = 0.004), and higher relative wall thickness (0.51 ± 0.16 vs. 0.46 ± 0.12, p = 0.0001). They had more frequently concentric remodeling (20.4% vs. 16.8%, p < 0.001), concentric hypertrophy (53.7% vs. 48.6%, p < 0.001), elevated filling pressures (25.8 vs. 12.1%, p = 0.0001), indexed left atrial volumes greater than 28 mL/m2 (17.2 vs. 11.2%, p = 0.001), and a reduced GLS less than −18% (74.2 vs. 47.7%, p < 0.0001). After adjustment for BP and BMI, T2DM remains an independent determinant factor for GLS decline (OR = 2.26, 95% CI 1.11–4.61, p = 0.023). Conclusions: Left ventricular geometry and subclinical LV function as assessed with GLS are more impaired in hypertensive patients with than without T2DM. Preventive approaches to control BMI and risk of T2DM in hypertensive patients should be emphasized.

Concentric hypertrophy geometry is a significant determinant of impaired global longitudinal strain in patients with normal cardiac structure and function

“…Diseases reportedly associated with impaired GLS include HT, type 2 DM associated with obesity, and renal insufficiency [ 1 , [10] , [11] , [12] ].…”

“…Studies have reported that GLS is impaired in aged, female, and overweight patients. [ 5 , 6 ] Several diseases have been associated with impaired GLS, including hypertension (HT), diabetes mellitus (DM), renal insufficiency, cardiomyopathies, and valvular heart disease (VHD) [ 1 , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. In patients with HT, impaired GLS is reportedly associated with concentric and dilated LV hypertrophy (LVH) patterns, independent of demographic and clinical parameters [ 14 ].…”

“…In patients with HT, impaired GLS is reportedly associated with concentric and dilated LV hypertrophy (LVH) patterns, independent of demographic and clinical parameters [ 14 ]. In addition, LV geometry and subclinical LV function as assessed by GLS are more impaired in hypertensive patients with type 2 DM than those without type 2 DM [ 11 ]. However, the determinant factors of impaired GLS in structurally and functionally normal patients have not yet been clarified.…”

Hemoglobin A1c in type 2 diabetes mellitus patients with preserved ejection fraction is an independent predictor of left ventricular myocardial deformation and tissue abnormalities

“…In addition, elevated ECV is associated with both decreased LV global function and LV remodeling in patients with HT [ 35 ]. Bendiab and colleagues investigated the impact of concomitant T2DM on subclinical cardiac function in a cohort of hypertensive patients and found that LV geometry and subclinical LV function as assessed with GLS were more impaired in hypertensive patients with T2DM than in those without T2DM; after adjustment for BP and BMI, T2DM remained an independent predictor of GLS decline (odds ratio = 2.26; 95% confidence interval, 1.11–4.61; p = 0.023) [ 36 ], which is consistent with the findings of our study.…”

Cardiac systolic and diastolic function in relation to cardiovascular risk factor distribution: a comparison of strain-rate imaging in Russian and Norwegian populations

“…Findings from these studies highlighted the overrepresentation of cardiovascular risk factors such as obesity, smoking, diabetes, and hypertension in the Russian population (2) which correlates with reduced cardiac function (9). Known factors like blood pressure, diabetes, body mass index (BMI), age, and sex are known to affect both systolic and diastolic cardiac functions (10,11). However, the speci c in uence of these factors on cardiac function within Russian and Western European populations remains unclear.Strain-rate (SR) imaging by two-dimensional speckle-tracking echocardiography (STE) is sensitive and speci c unmasking latent systolic and diastolic dysfunctions (12).…”