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Published on: February 23, 2012
Left ventricular chamber dilation and filling pressure may help to categorise patients with type 2 diabetes
Giacomo Zoppini1, Corinna Bergamini2, Stefano Bonapace3
1Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
Insights
Patients with type 2 diabetes and preserved ejection fraction (EF) can be identified into distinct clinical groups based on left ventricular end-diastolic volume and E/e' ratio. Those with higher values exhibit a worse clinical profile, suggesting a need for further prospective studies.
Area of Science:
- Cardiology
- Endocrinology
- Medical Imaging
Background:
- Type 2 diabetes mellitus (T2DM) is associated with cardiac structural and functional alterations.
- Diastolic dysfunction with preserved ejection fraction (EF) is common in T2DM patients.
- Recent criticisms of EF necessitate further investigation into other cardiac parameters.
Purpose of the Study:
- To investigate the impact of left ventricular end-diastolic volume (LVEDV) and E/e' ratio variations in T2DM patients with preserved EF.
- To identify distinct clinical phenotypes within this patient cohort.
- To correlate these phenotypes with clinical characteristics.
Main Methods:
- A cross-sectional study involving 176 men with T2DM and preserved EF (>50%).
- Transthoracic echocardiography was used for cardiac parameter assessment.
- Patients were stratified into four groups based on median LVEDV and E/e' ratio.
- Multinomial logistic regression analyzed independent predictors for group association.
Main Results:
- Significant differences were observed among groups in age, diabetes duration, EF, left atrial volume index (LAVI), septum thickness, and s' wave.
- Multinomial regression confirmed significant differences for age, diabetes duration, EF, LAVI, septum thickness, and s' wave.
- Patients in the higher LVEDV and E/e' ratio group (group 2) presented with a worse clinical profile.
Conclusions:
- Variations in LVEDV and E/e' ratio, even within normal ranges, can help identify T2DM phenotypes with poorer clinical characteristics.
- These identified phenotypes require validation in prospective studies to determine their predictive value.
Background:
Type 2 diabetes may alter cardiac structure and function. Many patients with type 2 diabetes have diastolic dysfunction with preserved ejection fraction (EF). Recently, this latter measure was criticised. Thus, this research looked at the impact of left ventricular end-diastolic volume and E/e' ratio variations in patients with type 2 diabetes and preserved EF with the aim to recognise different clinical phenotypes.
Methods:
In this cross-sectional study, we evaluated 176 men affected by type 2 diabetes with transthoracic echocardiography. All subjects have preserved EF (>50%). Patients were stratified into four groups based on the median value of both left ventricular end-diastolic volume and E/e' ratio, and the clinical variables were registered. The independent predictors associated with the groups were analysed by a multinomial logistic regression model.
Results:
Diabetes duration, age, estimated glomerular filtration rate and antihypertensive treatments were significantly different among the groups as were EF, left atrial volume index (LAVI), E/A, septum thickness and s' mean wave. Multinomial regression analysis showed that the groups significantly differed for age, diabetes duration, EF, LAVI, septum thickness and s' mean wave. The main result of this study was that patients with higher left ventricular volume and higher E/e' ratio (group 2) showed the worse clinical profile.
Conclusions:
Our study might suggest that variations of left ventricular end-diastolic volume along with E/e' ratio variations, even in the normal range, may allow to recognise phenotypes of patients with type 2 diabetes with worse clinical characteristics. This finding should be tested in prospective studies to assess the predictive roles of these phenotypes.
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