Clinical Science (2008) 114, 313-320 - P.M. Srivastava and others - Cardiac hypertrophy and dysfunction in patients with Type 2 diabetes

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Clinical Science (2008) 114, (313–320) (Printed in Great Britain)

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Prevalence and predictors of cardiac hypertrophy and dysfunction in patients with Type 2 diabetes

Piyush M. SRIVASTAVA*†, Paul CALAFIORE†, Richard J. MACISAAC*‡, Sheila K. PATEL*, Merlin C. THOMAS*§, George JERUMS*‡ and Louise M. BURRELL*

*Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria 3081, Australia, †Department of Cardiology, Austin Health, Heidelberg, Victoria 3081, Australia, ‡Endocrine Unit, Austin Health, Heidelberg Repatriation Hospital, Heidelberg, Victoria 3081, and §Baker Heart Research Institute, Melbourne, Victoria 8008, Australia

Key words: cardiovascular risk, echocardiography, left ventricular hypertrophy, tissue Doppler imaging, Type 2 diabetes.

Abbreviations: A, late diastolic peak filling velocity; Adur, A wave duration; AER, albumin excretion rate; BMI, body mass index; BSA, body surface area; BP, blood pressure; CHD, coronary heart disease; CHF, congestive heart failure; CI, confidence interval; CRP, C-reactive protein; DT, deceleration time; E, early diastolic peak filling velocity; EF, ejection fraction; HbA_1c, glycated haemoglobin; IVRT, isovolumic relaxation time; LA, left atrial; LDL, low-density lipoprotein; LV, left ventricular; LVH, LV hypertrophy; LVMI, LV mass index; MI, myocardial infarction; OR, odds ratio; PVD, peripheral vascular disease; TDI, tissue Doppler imaging E´, TDI-derived peak early diastolic filling velocity; S´, TDI-derived systolic myocardial velocity; Vp, flow propagation velocity.

Correspondence: Professor Louise M. Burrell (email l.burrell@unimelb.edu.au).

The aim of the present study was to determine the prevalence and predictors of an abnormal echocardiogram in patients with Type 2 diabetes. Cardiac function and structure were rigorously assessed by comprehensive transthoracic echocardiographic techniques in 229 patients with Type 2 diabetes. Cardiovascular risk factors and diabetic complications were assessed, and predictors of an abnormal echocardiogram were identified using multivariate logistic regression analysis. An abnormal echocardiogram was present in 166 patients (72%). LVH (left ventricular hypertrophy) occurred in 116 patients (51%), and cardiac dysfunction was found in 146 patients (64%), of whom 109 had diastolic dysfunction alone and 37 had systolic±diastolic dysfunction. Independent predictors of an abnormal echocardiogram were obesity, age, the number of antihypertensive drugs used (all P<0.001) and creatinine clearance (P<0.05). The risk of an abnormal echocardiogram increased by 9% for each year over 50 years of age {OR (odds ratio), 1.09 [95% CI (confidence interval), 1.04–1.15]}, 3-fold if obesity was present [BMI (body mass index) >30; OR, 4.2 (95% CI, 1.9–9.0)] and by 80% for each antihypertensive agent used [OR, 1.8 (95% CI, 1.3–2.4) per agent]. In conclusion, an abnormal cardiac echocardiogram is common in patients with Type 2 diabetes. Importantly, although cardiac abnormalities can be predicted by traditional risk factors, such as age, obesity and renal function, the absence of micro- or macro-vascular complications does not predict a normal echocardiogram. We suggest that an echocardiogram identifies those with Type 2 diabetes at increased cardiovascular risk due to occult LVH and diastolic dysfunction, and this information may lead to more aggressive management of known risk factors in the clinic.