Determinants of echocardiographically measured left ventricular mass in diabetic patients with or without silent...

Area of Science:

• Cardiology
• Diabetology
• Medical Imaging

Background:

• Left ventricular hypertrophy (LVH) is a significant independent risk factor for cardiovascular events.
• Diabetic patients often present with multiple cardiovascular risk factors and may have undiagnosed coronary artery disease.
• Understanding the determinants of LVH in this population is crucial for risk stratification and management.

Purpose of the Study:

• To investigate the factors determining left ventricular mass index (LVMI) in diabetic patients.
• To analyze these determinants in relation to the presence or absence of silent myocardial ischemia (SMI).
• To assess diabetic patients with at least two cardiovascular risk factors but no known coronary artery disease.

Main Methods:

• Echocardiography was used to measure LVMI in 80 diabetic patients (14 Type 1, 66 Type 2).
• Three non-invasive tests were employed: ECG stress test, thallium-201 myocardial scintigraphy with dipyridamole, and 48-h ambulatory ECG monitoring.
• Coronary angiography was performed in select cases to assess for significant coronary stenoses.

Main Results:

• Left ventricular hypertrophy (LVH) was prevalent, found in 45% of patients.
• Silent myocardial ischemia (SMI) was detected in 37% of patients; 7 had significant coronary stenoses.
• LVMI was higher with coronary stenoses and correlated with systolic blood pressure. In SMI-free patients, LVMI correlated with creatininemia. In SMI patients with normal coronaries, LVMI correlated with waist/hip ratio, albuminuria, and red blood cell filtration index.

Conclusions:

• LVH is highly frequent in diabetic patients.
• The primary determinants of increased LVMI differ based on SMI and coronary stenosis status.
• Volume load, microcirculatory disorders, and blood pressure are key factors influencing LVMI in diabetic patients with varying degrees of ischemic heart disease.