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Prevalence of left ventricular hypertrophy in Type I diabetic patients with diabetic nephropathy
A Sato1, L Tarnow, H H Parving
1Steno Diabetes Center, Gentofte, Denmark.
Insights
Diabetic nephropathy patients show increased left ventricular mass and impaired diastolic function, independent of systolic function. These cardiac changes occur early in kidney disease progression, highlighting cardiovascular risks in Type 1 diabetes.
Area of Science:
- Cardiology
- Nephrology
- Diabetology
Background:
- Diabetic nephropathy significantly increases cardiovascular disease mortality.
- Left ventricular hypertrophy is a known risk factor for myocardial ischemia and sudden cardiac death.
- Early detection of cardiac structural and functional changes in diabetic nephropathy is crucial.
Purpose of the Study:
- To evaluate left ventricular structure and function in Type 1 diabetic patients with diabetic nephropathy.
- To compare cardiac parameters between patients with and without diabetic nephropathy.
- To identify early cardiac alterations associated with diabetic nephropathy.
Main Methods:
- Cross-sectional study involving 105 Type 1 diabetic patients with diabetic nephropathy and 140 with normoalbuminuria.
- M-mode and Doppler echocardiography were used to assess left ventricular structure and function.
- Key parameters analyzed included left ventricular mass index, hypertrophy prevalence, and diastolic function indices (E/A ratio, isovolumic relaxation time).
Main Results:
- Patients with diabetic nephropathy exhibited a significantly increased left ventricular mass index (100.6 vs. 91.4 g/m², p=0.002).
- Left ventricular hypertrophy was more prevalent in the nephropathy group (23% vs. 9%, p<0.005).
- Diastolic function was impaired in patients with nephropathy, indicated by a reduced E/A ratio (1.17 vs. 1.34, p<0.001) and prolonged isovolumic relaxation time (81.7 vs. 74.6 ms, p=0.002). Systolic function remained comparable and normal in both groups.
Conclusions:
- An increased left ventricular mass index and impaired diastolic function are early findings in Type 1 diabetic nephropathy.
- These cardiac alterations occur independently of systolic function.
- The study underscores the importance of monitoring cardiac health in diabetic patients with nephropathy to mitigate cardiovascular risks.
Abstract:
The increased mortality of patients with diabetic nephropathy is mainly due to cardiovascular disease and end stage renal failure. Left ventricular hypertrophy is an independent risk factor for myocardial ischaemia and sudden death. The aim of our cross-sectional study was to evaluate left ventricular structure and function in Type I (insulin-dependent) diabetic patients with diabetic nephropathy. M-mode and Doppler echocardiography were done on 105 Type I diabetic patients with diabetic nephropathy [61 men, age (means +/- SD) 44+/-9 years, and albuminuria [median(range)] 567(10-8188) mg/24 h, serum creatinine 109 (53-558) micromol/l], and 140 Type I diabetic patients with persistent normoalbuminuria [79 men, 47+/-10 years, urinary albumin excretion rate 8 (0-30) mg/24 h, and serum creatinine 81 (55-121) micromol/l]. Patients with and without nephropathy were comparable with respect to sex, body mass index, and duration of diabetes. Arterial blood pressure was slightly higher in patients with nephropathy: 140/79 +/- 17/9 mm Hg vs 134/78 +/- 15/8 mm Hg, p < 0.01, and the majority of proteinuric patients received antihypertensive drugs, 84 vs 17 %, respectively, p < 0.001. Left ventricular mass index was increased in the nephropathic group (means +/- SD) 100.6+/-23.9 g/m2 compared with the normoalbuminuric group 91.4+/-21.9 g/m2, p = 0.002. Left ventricular hypertrophy was found more often in patients with nephropathy 23 (14-31)% compared with patients with normoalbuminuria 9 (5-14)%, p < 0.005. Diastolic function, assessed by the ratio between the peak diastolic velocity and the peak atrial systolic velocity (E/A ratio) and isovolumic relaxation time, was reduced in patients with vs without nephropathy: 1.17+/-0.29 vs 1.34+/-0.32, and 81.7+/-16.5 vs 74.6+/-14.5, p < 0.001 and p = 0.002, respectively. Systolic function was about the same and normal in both groups. Our study suggests that an increase in left ventricular mass index and a decrease in diastolic function occurs early in the course of diabetic nephropathy.