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Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic
1Cattedra di Medicina Interna, Dipartimento di Medicina Interna, Malattie Cardiovascolari e NefroUrologiche, Excellence Centre of the European Society of Hypertension, Università degli Studi di Palermo, Palermo, Italy. emilionardi@virgilio.it
Insights
Type 2 diabetes significantly worsens left ventricular hypertrophy (LVH) and diastolic dysfunction in hypertensive patients with chronic kidney disease (CKD). Diabetes is linked to thicker heart walls and poorer diastolic function, independent of other factors.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Left ventricular hypertrophy (LVH) and diastolic dysfunction are prevalent in chronic kidney disease (CKD).
- The impact of type 2 diabetes on cardiac structure and function in CKD patients requires further elucidation.
- Hypertension is a common comorbidity in CKD, influencing cardiovascular outcomes.
Purpose of the Study:
- To assess the effect of type 2 diabetes on left ventricular (LV) geometry and diastolic function.
- To investigate the association between diabetes, LVH, and diastolic dysfunction in hypertensive CKD patients.
- To identify independent predictors of diastolic dysfunction in this patient cohort.
Main Methods:
- A study involving 288 Caucasian hypertensive CKD patients, with 112 having type 2 diabetes.
- Exclusion criteria included cardiovascular disease, GFR >60 ml/min/1.73m², dialysis, and major non-CV diseases.
- Echocardiography with tissue Doppler imaging (TDI) and biochemical analyses were performed.
Main Results:
- Diabetic patients exhibited significantly increased LV wall thicknesses, relative wall thickness (RWT), and left atrium volume index.
- A higher prevalence of concentric LVH was observed in diabetic patients.
- Early diastolic filling (Em) measured by TDI was significantly lower in diabetic patients, an association independent of confounders.
Conclusions:
- Type 2 diabetes is associated with increased LV wall thickness and concentric geometry in hypertensive CKD patients.
- Diabetes, along with renal function (GFR), independently predicts worse diastolic function in this population.
- These findings highlight the detrimental cardiovascular impact of diabetes in CKD patients.
Abstract:
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) >60 ml min(-1) 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=0.0001), relative wall thickness (RWT) (P=0.0001) and left atrium volume index (P=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=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 (β 0.364; P=0.0001), GFR (beta 0.101; P=0.019), and the presence of diabetes (β 0.166; P=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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