Diastolic dysfunction in the diabetic continuum: association with insulin resistance, metabolic syndrome and type 2 diabetesReport as inadecuate




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Cardiovascular Diabetology

, 14:4

First Online: 13 January 2015Received: 29 October 2014Accepted: 27 December 2014

Abstract

BackgroundDiabetes increases the risk of heart failure but the underlying mechanisms leading to diabetic cardiomyopathy are poorly understood. Left ventricle diastolic dysfunction LVDD is one of the earliest cardiac changes in these patients. We aimed to evaluate the association between LVDD with insulin resistance, metabolic syndrome MS and diabetes, across the diabetic continuum.

MethodsWithin a population-based study EPIPorto, a total of 1063 individuals aged ≥45 years 38% male, 61.2 ± 9.6 years were evaluated. Diastolic function was assessed by echocardiography, using tissue Doppler analysis E’ velocity and E-E’ ratio according to the latest consensus guidelines. Insulin resistance was assessed using the Homeostasis Model Assessment of Insulin Resistance HOMA-IR score.

ResultsThe HOMA-IR score correlated to E’ velocity ρ = −0.20;p < 0.0001 and E-E’ ratio ρ = 0.20; p < 0.0001. There was a progressive worsening in E’ velocity p for trend < 0.001 and in E-E’ ratio across HOMA-IR quartiles p for trend <0.001. Individuals in the highest HOMA-IR quartile were more likely to have LVDD, even after adjustment for age, sex, blood pressure and body mass index adjusted OR: 1.82; 95% CI: 1.09-3.03. From individuals with no MS, to patients with MS and no diabetes, to patients with diabetes, there was a progressive decrease in E’ velocity 11.2 ± 3.3 vs 9.7 ± 3.1 vs 9.2 ± 2.8 cm-s; p < 0.0001, higher E-E’ 6.9 ± 2.3 vs 7.8 ± 2.7 vs 9.0 ± 3.6; p < 0.0001 and more diastolic dysfunction adjusted OR: 1.62; 95% CI: 1.12-2.36 and 1.78; 95% CI: 1.09-2.91, respectively.

ConclusionsHOMA-IR score and metabolic syndrome were independently associated with LVDD. Changes in diastolic function are already present before the onset of diabetes, being mainly associated with the state of insulin resistance.

KeywordsInsulin resistance Diabetes Diastole Diabetic cardiomyopathy Electronic supplementary materialThe online version of this article doi:10.1186-s12933-014-0168-x contains supplementary material, which is available to authorized users.

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Author: Ricardo Fontes-Carvalho - Ricardo Ladeiras-Lopes - Paulo Bettencourt - Adelino Leite-Moreira - Ana Azevedo

Source: https://link.springer.com/article/10.1186/s12933-014-0168-x



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