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CLINICAL RESEARCH: HEART FAILURE

Association of albuminuria with systolic and diastolic left ventricular dysfunction in type 2 diabetes

The Strong Heart Study

Jennifer E. Liu, MD, FACC^,*, David C. Robbins, MD, Vittorio Palmieri, MD^*, Jonathan N. Bella, MD, FACC^*, Mary J. Roman, MD, FACC^*, 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
Division of Cardiology, 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, DC, 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 May 30, 2002; revised manuscript received December 2, 2002, accepted December 12, 2002.

^* 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, USA.
jeliu{at}med.cornell.edu

OBJECTIVES: We sought to compare systolic and diastolic function in American Indians with diabetes mellitus (DM) based on albuminuria status.

BACKGROUND: Albuminuria has been shown to predict cardiovascular disease (CVD) in populations with DM. However, the mechanism of the association of albuminuria and CVD is unclear.

METHODS: We compared echo-derived indices of left ventricular (LV) systolic and diastolic function in three groups of American Indians with DM based on albuminuria status: I = no albuminuria (<30 mg albumin/g creatinine); II = microalbuminuria (30 to 300 mg/g); and III = macroalbuminuria (>300 mg/g).

RESULTS: Group II and III were slightly older than Group I with no significant gender difference between groups. Systolic blood pressure increased and body mass index decreased from Group I to Group III. Left ventricular systolic function was lower in the groups with albuminuria with step-wise decreases in ejection fraction and stress-corrected midwall shortening (MWS) from Group I to Group III. Similar findings were noted in diastolic LV filling with lower mitral E/A ratios and longer deceleration times in groups with albuminuria. The proportion of participants with abnormal MWS and abnormal LV diastolic relaxation showed step-wise increases from no albuminuria to macroalbuminuria. In multivariate analysis, albuminuria status remained independently associated with both systolic and diastolic dysfunction after adjusting for age, gender, body mass index, systolic blood pressure, duration of diabetes, coronary artery disease, and LV mass.

CONCLUSIONS: Albuminuria is independently associated with LV systolic and diastolic dysfunction in type 2 DM; this may explain in part the relationship of albuminuria to increased cardiovascular (CV) events in the DM population. Screening for albuminuria identifies individuals with high CV risk and possible cardiac dysfunction.

Abbreviations and Acronyms   CHD   coronary heart disease   CV   cardiovascular   CVD   cardiovascular disease   DM   diabetes mellitus   ECG   electrocardiogram/electrocardiographic   LV   left ventricular   MWS   midwall shortening   SHS   Strong Heart Study

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