CLINICAL STUDY: DIASTOLIC DYSFUNCTION
The impact of diabetes on left ventricular filling pattern in normotensive and hypertensive adults: the strong heart study
Jennifer E. Liu, MD*,
Vittorio Palmieri, MD*,
Mary J. Roman, MD, FACC*,
Jonanthan N. Bella, MD*,
Richard Fabsitz, MA ,
Barbara V. Howard, PhD ,
Thomas K. Welty, MD, MPH ,
Elisa T. Lee, PhD|| and
Richard B. Devereux, MD, FACC*
* Department of Medicine, the New York Hospital-Cornell Medical Center, New York, New York, USA
National Heart Lung and Blood Institute, Bethesda, Maryland, USA
Medstar Research Institute, Washington, D.C, USA
Aberdeen Area Tribal Chairmen’s Health Board, Rapid City, South Dakota, USA
|| School of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
Manuscript received August 30, 2000;
revised manuscript received January 23, 2001,
accepted February 6, 2001.
Reprint requests and correspondence: Dr. Jennifer E. Liu, Division of Cardiology, Box 222, The New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, New York 10021
jeliu{at}med.cornell.edu
OBJECTIVES
We sought to determine the effect of diabetes mellitus (DM) on left ventricular (LV) filling pattern in normotensive (NT) and hypertensive (HTN) individuals.
BACKGROUND
Diastolic abnormalities have been extensively described in HTN but are less well characterized in DM, which frequently coexists with HTN.
METHODS
We analyzed the transmitral inflow velocity profile at the mitral annulus in four groups from the Strong Heart Study: NT-non-DM (n = 730), HTN-non-DM (n = 394), NT-DM (n = 616) and HTN-DM (n = 671). The DM subjects were further divided into those with normal filling pattern (n = 107) and those with abnormal relaxation (AbnREL) (n = 447).
RESULTS
The peak E velocity was lowest in HTN-DM, intermediate in NT-DM and HT-non-DM and highest in the NT-non-DM group (p < 0.001), with a reverse trend seen for peak A velocity (p < 0.001). In multivariate analysis, E/A ratio was lowest in HTN-DM and highest in NT-non-DM, with no difference between NT-DM and HTN-non DM (p < 0.001). Likewise, mean atrial filling fraction and deceleration time were highest in HTN-DM, followed by HTN-non-DM or NT-DM and lowest in NT-non-DM (both p < 0.05). Among DM subjects, those with AbnREL had higher fasting glucose (p = 0.03) and hemoglobin A1C (p = 0.04).
CONCLUSIONS
Diabetes mellitus, especially with worse glycemic control, is independently associated with abnormal LV relaxation. The severity of abnormal LV relaxation is similar to the well-known impaired relaxation associated with HTN. The combination of DM and HTN has more severe abnormal LV relaxation than groups with either condition alone. In addition, AbnREL in DM is associated with worse glycemic control.
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Abbreviations and Acronyms
| | AGES | = advanced-glycated end products | | CESS | = circumferential end-systolic stress | | DM | = diabetes mellitus | | DT | = deceleration time | | HTN | = hypertension | | LV | = left ventricular | | NT | = normotensive | | SBP | = systolic blood pressure | | SHS | = Strong Heart Study |
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