Effects of blood pressure lowering and metabolic control on systolic left ventricular function in Type II diabetes mellitus.

Medical Department M (Diabetes and Endocrinology) and The Medical Research Laboratories, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
Clinical Science (Impact Factor: 5.63). 08/2006; 111(1):53-9. DOI: 10.1042/CS20050367
Source: PubMed

ABSTRACT Decreased left ventricular long-axis function may be the earliest stage in subclinical heart failure in Type II diabetes. To assess whether a decrease in SBP (systolic blood pressure) or a change in metabolic control would improve the long-axis function, 48 Type II diabetic patients participating in the CALM II (Candesartan and Lisinopril Microalbuminuria II) study were included in the present study. Patients were examined with tissue Doppler echocardiography at baseline and after 3 and 12 months of follow-up. Corresponding blood pressure, fructosamine and HbA(1c) (glycated haemoglobin) values were obtained. During the follow-up period, a decrease in SBP of 8 mmHg was seen (from 141+/-11 mmHg at baseline to 133+/-12 mmHg; P<0.001) and the peak systolic strain rate was significantly improved (from -1.10+/-0.25 at baseline to -1.25+/-0.22; P<0.01). There was a highly significant relationship between the changes in systolic strain rate, HbA(1c) (P<0.001) and fructosamine (P<0.05), and similarly to changes in left ventricular mass (P<0.05), whereas the correlation to the SBP reduction was not significant. Patients with improved glycaemic control, defined as a reduced HbA(1c) value after 12 months of follow-up, had a significantly improved strain rate (from -1.07+/-0.3 s(-1) at baseline to -1.32+/-0.25 s(-1); P<0.01) compared with patients with increases in HbA(1c) (from -1.14+/-0.25 s(-1) at baseline to -1.16+/-0.27 s(-1); P=not significant). The two groups had comparable baseline values of SBP, left ventricular mass, age and disease duration. In conclusion, changes in left ventricular systolic long-axis function are significantly correlated with changes in left ventricular mass, as well as metabolic control, in hypertensive patients with Type II diabetes mellitus.

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    ABSTRACT: Background: Impaired left ventricular (LV) function is shown by strain rate (SR) imaging in patients with diabetes mellitus (DM). Left atrium (LA) function in patients with DM, however, has not been assessed by this method and the effect of hypertension (HT) on LV and LA functions in diabetic patients has not been fully studied. The aim of this study was to quantitatively assess LA function in diabetic patients with and without HT in combination with LV function. Methods: Conventional echocardiographic and SR imaging studies were performed in 55 subjects with normal systolic LV function (LV ejection fraction of 55% or more) and no evidence of coronary artery disease: 17 with DM (DM group), 22 who have both DM and HT (DM+HT group), and 16 age-matched controls. SR imaging was performed from three apical views, and peak SR was measured at 12 LV segments and 5 LA segments. Mean peak systolic SR (LVs and LAs, respectively), early diastolic SR (LVe and LAe, respectively) and late diastolic SR (LVa and LAa, respectively) were calculated by averaging data in each LV and LA segment. Results: Despite no significant differences in age, LV ejection fraction and E/A ratio among the three groups, systolic blood pressure, LA dimension and LV mass index in the DM+HT group were significantly larger than those in the controls. The DM group had reduced systolic and diastolic LV functions and impaired LA reservoir and conduit functions compared with those in the controls, as shown by lower LVs (P < 0.05), LVe (P < 0.01), LAs (P < 0.01), and LAe (P < 0.05). The DM+HT group had reduced LVs (P < 0.01), LVe (P < 0.01), LAs (P < 0.01) and LAe (P < 0.01) compared with those in the controls. The DM+HT group had significantly lower LVe (P < 0.05) and LAe (P < 0.05) than did the DM group. Conclusions: SR imaging can detect impairment of LA reservoir and conduit functions as well as LV systolic and diastolic dysfunctions in patients with DM, even in the absence of LV hypertrophy and LA dilatation. Coexisting HT augments the impairment of LV diastolic and LA conduit functions in diabetic patients.
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    ABSTRACT: Although diabetes mellitus is well known to result in systolic and diastolic left ventricular (LV) dysfunction at the subclinical level, even when it is not accompanied by hypertension and coronary artery disease, this situation has not been sufficiently investigated in prediabetes, which is the precursor of diabetes. The aims of the present study were to investigate LV systolic and diastolic function in normotensive and low-risk prediabetic and diabetic subjects for coronary disease using sensitive tissue Doppler echocardiographic parameters, to investigate early possible negative effects of glucose metabolism impairment on LV longitudinal function. Two hundred subjects (92 with prediabetes, 48 with type 2 diabetes, and 60 age-matched healthy volunteers) were studied by conventional, tissue Doppler, and strain and strain rate echocardiography. All study subjects were normotensive, and coronary artery disease was excluded. Forty-eight patients had isolated fasting glucose impairment, and 44 patients had combined fasting glucose and glucose tolerance impairment. Longitudinal peak systolic strain and the peak systolic and diastolic strain rates of six walls in the apical four-chamber, long-axis, and two-chamber views were evaluated. Clinical and standard echocardiographic characteristics were comparable among all groups. Mean systolic (P = .01) and diastolic (P = .02) tissue velocities, mean strain (P = .004), and mean systolic (P = .002) and diastolic (P = .001) strain rates were significantly lower in the diabetic groups than in control subjects. There were no difference between patients with isolated fasting glucose impairment and controls for tissue Doppler parameters, but mean early diastolic tissue velocity and mean strain and strain rates were statistically lower in patients with combined fasting glucose and glucose tolerance impairment compared with controls (P < .05). LV longitudinal systolic and diastolic function was impaired in both normotensive diabetic and prediabetic patients.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 12/2011; 25(3):349-56. · 2.98 Impact Factor
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    ABSTRACT: Dan Med Bull 2010; 57: (6) B4150 THE EIGHT ORIGINAL PAPERS ARE: 1. Evaluation of the longitudinal contraction of the left ventricle in normal subjects by Doppler tissue tracking and strain rate Andersen NH, Poulsen SH J Am Soc Echocardiogr. 2003 Jul;16(7):716-23 2. Influence of preload alterations on parameters of systolic left ven-tricular long-axis function: a Doppler tissue study. Andersen NH, Terkelsen CJ, Sloth E, Poulsen SH J Am Soc Echocardiogr. 2004 Sep;17(9):941-7 3. Doppler tissue imaging reveals systolic dysfunction in patients with hypertension and apparent "isolated" diastolic dysfunction Poulsen SH, Andersen NH, Ivarsen PI, Mogensen CE, Egeblad H J Am Soc Echocardiogr. 2003 Jul;16(7):724-31 4. Diastolic dysfunction after an acute myocardial infarction in patients with antecedent hypertension Andersen NH, Karlsen FM, Gerdes JC, Kaltoft A, Bøttcher M, Sloth E, Thuesen L,Bøtker HE, Poulsen SH J Am Soc Echocardiogr. 2008 Feb;21(2):171-7 5. Decreased left ventricular longitudinal contraction in normotensive and normoalbuminuric patients with Type II diabetes mellitus: a Dop-pler tissue tracking and strain rate echocardiography study Andersen NH, Poulsen SH, Eiskjaer H, Poulsen PL, Mogensen CE Clin Sci (Lond). 2003 Jul;105(1):59-66 6. Left ventricular dysfunction in hypertensive patients with Type 2 diabetes mellitus Andersen NH, Poulsen SH, Poulsen PL, Knudsen ST, Helleberg K, Han-sen KW, Berg TJ, Flyvbjerg A, Mogensen CE Diabet Med. 2005; Sep;22(9):1218-25 7. Effects of blood pressure lowering and metabolic control on systolic left ventricular function in Type II diabetes mellitus Andersen NH, Poulsen SH, Poulsen PL, Knudsen ST, Helleberg K, Han-sen KW, Dinesen DS, Eiskjaer H, Flyvbjerg A, Mogensen CE Clin Sci (Lond). 2006 Jul;111(1):53-9 8. Changes in glycaemic control are related to the systolic function in type 1 diabetes mellitus Andersen NH, Hansen TK, Christiansen JS Scand Cardiovasc J. 2007 Apr;41(2):85-8 INTRODUCTION Congestive heart failure (CHF) is a disabling disease with consi-derable morbidity and mortality rates, despite great advances in heart failure treatment (1;2). The number of patients with congestive heart failure is rapidly increasing in the western world with a prevalence estimated at 1– 2 % and an incidence close to 5–10 per 1000 persons per year (3). The mounting congestive heart failure incidence is closely related to the increasing number of patients with hypertension and diabetes (4). The worldwide estimated number of adults with hypertension was 972 million in 2000; 639 million live in develop-ing countries. By 2025, the total number is expected to increase to 1·56 billion (5). The risk of developing CHF in a hypertensive cohort is about 2-fold in men and 3-fold in women as compared to normotensive individuals (4). Also in population based studies, hypertension is significantly related to development of CHF, ac-counting for 39 % of cases of CHF in men and 59 % in women (4). A similar exponential increase in type 2 diabetes incidence is evident. According to numbers from the WHO, there will be up to 366 million individuals with type 2 diabetes in 2030. The prevalence of CHF in a diabetic population is 5-8 fold higher compared to a non-diabetic population (6;7), and the risk of heart failure hospitalization in the UKPDS study was equal to that of non-fatal myocardial infarction, stroke or renal failure (8). Unfortunately, a large number of patients with diabetes mellitus have coexisting hypertension, which significantly increases the risk of heart failure dramatically (9;10). Hypertension and diabetes are both characterized by long asymp-tomatic periods, where patients are unaware of their subclinical diseases and thereby remain untreated (11). Recent data derived from the VALUE study showed that hypertensive patients with new-onset diabetes had significantly higher cardiac morbidity, especially increased congestive heart failure incidence, compared to hypertensive patients without diabetes (hazard ratio of 1.43
    Danish Medical Journal 06/2010; 57(6):B4150. · 0.61 Impact Factor

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