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Effect of diabetes and hypertension on left ventricular diastolic function in a high‐risk population without evidence of heart disease
Author(s) -
Russo Cesare,
Jin Zhezhen,
Homma Shunichi,
Rundek Tatjana,
Elkind Mitchell S.V.,
Sacco Ralph L.,
Di Tullio Marco R.
Publication year - 2010
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfq022
Subject(s) - medicine , cardiology , diabetes mellitus , diastole , overweight , population , heart failure , diastolic heart failure , blood pressure , obesity , endocrinology , environmental health
Aims To assess the independent and combined effects of diabetes and hypertension on left ventricular (LV) diastolic function in a community‐based cohort at high cardiovascular risk. Methods and results Two‐dimensional echocardiography was performed in 708 subjects from the Cardiac Abnormalities and Brain Lesions (CABL) study. Peak diastolic early (E) and late (A) transmitral flow, and tissue Doppler‐derived early mitral annulus velocity ( E ′) were recorded, and E / A and E / E ′ ratios were calculated. The population was divided into four groups: those without hypertension or diabetes (HT−/DM−), those with only hypertension (HT), only diabetes (DM), and with hypertension plus diabetes (HT + DM). In multivariate analysis, hypertension and diabetes were independent predictors of worse diastolic function. The coexistence of hypertension and diabetes was associated with greater impairment of diastolic function (higher E / E ′ ratio than HT−/DM−, HT, or DM, all P < 0.05), independent of covariates. The negative, synergistic effect of hypertension and diabetes on LV diastolic function was present both in lean participants and in overweight/obese ones. An E / E ′ ratio >15, suggestive of increased LV filling pressure, was found in 2.2% of HT−/DM−, 8.9% of HT, 5.9% of DM, and 14.7% of HT + DM ( P < 0.01). Conclusion Hypertension and diabetes are independently associated with impaired LV diastolic function, independent of the effect of overweight/obesity and other covariates. Their coexistence results in a negative synergistic effect on LV diastolic mechanics and is associated with higher LV filling pressures than either condition alone.