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Left ventricular diastolic filling in diabetes mellitus with and without hypertension
A Nicolino1, G Longobardi, G Furgi
1Fondazione Clinica del Lavoro, IRCCS, Divisione di Cardiologia, Italy.
Insights
Diabetic patients often show altered left ventricular diastolic filling, which worsens with arterial hypertension. This study highlights impaired relaxation in hypertensive diabetics, impacting heart function.
Area of Science:
- Cardiology
- Diabetology
- Echocardiography
Background:
- Diabetes mellitus is a significant risk factor for cardiovascular complications.
- Diastolic dysfunction is an early indicator of cardiac impairment in diabetic patients.
- The impact of coexisting arterial hypertension on diabetic diastolic function requires further elucidation.
Purpose of the Study:
- To investigate left ventricular diastolic filling patterns in diabetic patients using Doppler echocardiography.
- To compare diastolic function between normotensive and hypertensive diabetic individuals.
- To assess the influence of arterial hypertension on diastolic dysfunction in diabetes.
Main Methods:
- Doppler echocardiography was used to assess left ventricular diastolic filling in 84 diabetic patients and 84 controls.
- Diabetic patients were categorized into normotensive (Group 1) and hypertensive (Group 2) subgroups.
- Diastolic dysfunction was defined by at least two abnormal Doppler indices.
Main Results:
- Diabetic patients exhibited significantly altered diastolic filling compared to controls.
- Hypertensive diabetics (Group 2) showed more pronounced alterations, including increased atrial flow velocity and decreased early filling ratios.
- Diastolic dysfunction was present in 32% of normotensive and 40% of hypertensive diabetics, associated with increased ventricular wall thickness and mass.
Conclusions:
- Left ventricular diastolic filling is frequently impaired in diabetic patients.
- Arterial hypertension exacerbates diastolic dysfunction in diabetes, leading to further impairment of left ventricular relaxation.
- Doppler echocardiography is valuable for detecting subclinical diastolic abnormalities in diabetic populations.
Abstract:
Left ventricular diastolic filling by Doppler echocardiography was investigated in 84 diabetic patients without evidence of heart disease and in 84 normotensive nondiabetic age- and sex-matched control subjects. Diabetic patients were subdivided into two groups on the basis of the presence of arterial hypertension. Group 1 comprised 41 normotensive diabetic patients (19 men, 22 women, mean age 63.7 +/- 9.1 years); Group 2 comprised 43 hypertensive diabetics (15 men, 28 women, mean age 65.6 +/- 9.6 years). Doppler measures of diastolic filling were significantly altered in the two groups as compared with control subjects. Peak atrial flow velocity, velocity integral for the atrial filling period, and atrial filling fraction were increased, whereas the ratio of peak early to peak atrial flow velocity and the ratio of flow velocity integrals were decreased, especially in Group 2 patients. Thirteen patients in Group 1 (32%) and 17 in Group 2 (40%) had evidence of diastolic dysfunction, as assessed by the presence of at least two independent abnormal indices (outside age-corrected 95% confidence interval). In each group, patients with altered diastolic filling differed slightly from diabetic patients with normal Doppler indices, tending to increased wall thickness and left ventricular mass. In conclusion, diastolic filling of the left ventricle is frequently altered in diabetic patients and is adversely affected by arterial hypertension whose coexistence further impairs left ventricular relaxation.