Myocardial structure and function by echocardiography in relation to glucometabolic status in elderly subjects from 2 population-based cohorts: A cross-sectional study

Department of Cardiology, Malmö University Hospital, Malmö, Sweden.
American heart journal (Impact Factor: 4.46). 03/2010; 159(3):414-420.e4. DOI: 10.1016/j.ahj.2009.12.028
Source: PubMed


Left ventricular (LV) diastolic dysfunction has been associated with impaired glucometabolic status. However, studies of older subjects are lacking. We examined associations between echocardiographic indices of LV diastolic function and LV mass index (LVMI) and glucometabolic status among middle-aged and elderly subjects free from heart disease, hypothesizing that the associations would be comparative to younger cohorts.
We examined the Age Gene/Environment Susceptibility Reykjavik Study (Iceland; n = 607, 76 +/- 6 years) and the Malmö Preventive Project Re-Examination Study (MPP-RES) cohorts (Sweden; n = 1,519, 67 +/- 6 years), evaluating associations with multivariable regression analysis.
In the Age Gene/Environment Susceptibility Reykjavik Study, LVMI was positively correlated with glycosylated hemoglobin (HbA1c) (P = .001). Otherwise, echocardiographic variables were not associated with glucometabolic status. In the MPP-RES, LVMI increased with increasing glucometabolic disturbance among both older (70-80 years) and middle-aged (57-69 years) subjects. Among older subjects, HbA1c was positively correlated with 2 variables reflecting LV diastolic function: late transmitral peak flow velocity (A) (P = .001) and early transmitral peak flow velocity (E)/early diastolic peak tissue velocity (Em) (P = .046). In middle-aged MPP-RES subjects, increasing glucometabolic disturbance was correlated with increasing late diastolic peak tissue velocity (Am) (P = .002) and, after age adjustment, with increasing A (P = .001) and decreasing Em/Am (P = .009). With age adjustment, Am and A were positively correlated with fasting glucose and HbA1c.
Contrary to our hypothesis, in 2 independent cohorts of older individuals, associations between glucometabolic status and LV diastolic function were generally weak. These contrast with previous reports, as well as with observations among middle-aged subjects in the present study. Changes in LV diastolic function may be more age-related than associated with glucose metabolism in older subjects.

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    • "A mean of 3–5 cycles was used. The intra-and interobserver variability is reported elsewhere [24]. Diastolic function was graded according to the recommendations of ASE and EACVI (formerly known as the European Association of Echocardiography) [25], using age-appropriate cut-off values of septal é, lateral é, E-wave DT, E/A, and averaged E/é. "
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    ABSTRACT: Background/objectives: To examine whether higher fasting plasma glucose (FPG) levels were independently associated with left ventricular (LV) mass and/or geometry in elderly, otherwise healthy subjects. Methods: We tested cross-sectional associations between echocardiographically determined LV mass/geometric patterns, cardiovascular risk factors, and FPG categorized as normal fasting glucose (NFG), impaired fasting glucose (IFG), and untreated diabetes mellitus (DM), in 486 men and 207 women aged 56–79 years without overt cardiovascular disease, who received no cardiovascular, anti-diabetic, or lipid-lowering drugs and had a preserved LV ejection fraction >50%. Results: Unadjusted mean LV mass index (LVMI) was significantly greater among subjects with DM than those without (90 +/− 26 g/m2 vs. 85 +/− 20 g/m2, p = 0.01), as were both relative wall thickness (RWT) (0.43 +/− 0.09 vs. 0.40 +/− 0.08, p = 0.01) and prevalence of concentric LV hypertrophy (LVH) (11% vs. 6%, p = 0.03). However, only RWT remained significantly associated with the presence of DM after multivariable adjustment (p = 0.04). Interaction analyses revealed that greater LVMI/LVH was predominantly associated with higher levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) among subjects with IFG orDM, but notNFG. Conclusions: Subjects with untreated DMhad higher values of LVMI and a greater prevalence of concentric LVH, but the associations were not independent of other risk factors. NT-proBNP was primarily associated with greater LV size in subjects with IFG or DM.
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    • "These subjects were randomly selected from groups defined by glucometabolic status: normal fasting plasma glucose (FPG) (≤6.0 mmol/l); impaired FPG (IFG); new-onset type 2 diabetes mellitus; and prevalent diabetes mellitus; with oversampling in groups of subjects with glucometabolic disturbances to ensure sufficient numbers of subjects studied from each group. A full description of this study population has been presented elsewhere [20]. Subjects with prevalent diabetes mellitus type 1 or 2 (n = 677) were excluded from our analysis due to previously shown overrepresentation of diastolic dysfunction and LVH within the diabetic phenotype [11,16,17], resulting in a total of 1,115 subjects. "
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    • "If the FPG measured at the first visit was elevated (≥ 7.0 mmol/L), new blood samples were drawn on the second visit. In a sub-sample of participants (n = 1792) echocardiography and ECG recording were performed, and levels of s-Nt proBNP, s-cystatin C and HbA1c were measured at a separate visit [9]. "
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    Full-text · Article · Dec 2011 · Cardiovascular Diabetology
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