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Relationship between diastolic hypertension and myocardial morphology and function in elderly males with diabetes
Insights
Diabetic cardiomyopathy is not distinct in older men; myocardial changes were limited to increased left atrial size and impaired diastolic function, independent of hypertension. This study investigated cardiac structure in diabetes.
Area of Science:
- Cardiology
- Diabetology
- Gerontology
Background:
- Diabetic cardiomyopathy, characterized by increased left ventricular mass, has been suggested.
- Diabetes mellitus is linked to left ventricular hypertrophy and hypertension, requiring consideration of blood pressure's confounding effect.
- This study examines cardiac structure in elderly males with and without diabetes.
Purpose of the Study:
- To investigate whether a distinct diabetic cardiomyopathy exists in elderly males, independent of hypertension.
- To assess left ventricular mass and diastolic function in normotensive diabetic individuals compared to controls.
- To evaluate myocardial alterations in relation to diabetes and co-existing hypertension.
Main Methods:
- Cross-sectional echocardiographical examination in 582 males aged 70 years.
- Comparison of normotensive diabetic subjects (n=30) with non-insulin-dependent diabetes (NIDDM) and hypertension (n=10) and normotensive controls (n=203).
- Exclusion of subjects with coronary heart disease or regular antihypertensive treatment.
Main Results:
- Both NIDDM groups showed significantly increased left atrial diameter and impaired diastolic function (A-wave) compared to controls.
- Left ventricular mass was only marginally and not significantly elevated in diabetic subjects versus controls.
- The intraventricular septum was significantly enlarged only in subjects with both diabetes and hypertension.
Conclusions:
- No distinct diabetic cardiomyopathy with increased left ventricular mass, independent of hypertension, was detected in this sample of elderly males.
- Myocardial alterations in diabetic males were confined to increased left atrial size and impaired diastolic function.
- Hypertension appears to be a significant factor in left ventricular hypertrophy in diabetic individuals.
Abstract:
The existence of a distinct diabetic cardiomyopathy, characterized by a raised left ventricular mass, has previously been suggested. However, as diabetes mellitus is associated with both left ventricular hypertrophy and hypertension a confounding effect of raised blood pressure in diabetic patients has to be considered. In the present cross-sectional study an echocardiographical examination was performed as part of a health screening survey in 582 males, aged 70 years. After the exclusion of subjects with coronary heart disease or those on regular antihypertensive treatment, 30 normotensive subjects with diabetes were compared with 10 subjects with non-insulin-dependent diabetes (NIDDM) and a diastolic blood pressure 90 mm Hg or more and 203 normotensive control subjects with normal glucose tolerance. Both groups with NIDDM showed a significantly increased left atrial diameter (4.4 +/- 0.7 vs 4.0 +/- 0.5 cm, p < 0.05) and an increased atrial component in diastole (A-wave, p < 0.01) compared to the control subjects. Left ventricular mass was, however, only marginally and not significantly elevated in the diabetic subjects when compared to the healthy control subjects (133 +/- 19 and 133 +/- 28 vs 128 +/- 25 g/m2). Only in the subjects with concomitant diabetes and a raised blood pressure was the intraventricular septum significantly enlarged (p < 0.05). Thus, in the present sample no distinct diabetic cardiomyopathy with an increased left ventricular mass, independent of the influence of hypertension could be detected. The myocardial alterations in these diabetic males were restricted to an increased left atrial size and an impaired diastolic function.