Chonnam Med J.  2009 Apr;45(1):27-32. 10.4068/cmj.2009.45.1.27.

Impact of Diabetes on the Left Ventricular Long Axis and Midwall Function in Patients with Hypertension

Affiliations
  • 1Department of Cardiology, Kyunghee East-West Neo Medical Center, Seoul, Korea. issohn@khu.ac.kr

Abstract

Diabetes mellitus (DM) is a strong risk factor for cardiovascular morbidity and mortality. It is suggested that both hypertension and DM may synergistically affect left ventricular (LV) structure and function. To assess whether hypertensive patients with DM have more depressed LV function in terms of long axis and midwall function by use of tissue Doppler echocardiogram than do patients with hypertension only. Hypertensive patients (n=200) and hypertensive patients with DM (n=60), all of whom had normal LV ejection fraction, were recruited for the study. Healthy age- and sex-matched subjects (n=20) served as the control group. Echocardiography was performed including LV wall thickness, dimension, Doppler, and tissue Doppler imaging. Blood pressure (BP) was measured in the supine position before and after echocardiographic examination. The hypertensive patients with or without DM had higher BP and LV wall thickness, had more decreased afterload measured by meridional end-systolic stress, and had more depressed LV diastolic, long axis, and global function than did the controls. There was no difference in LV function between the hypertensive patients with and without DM. The hypertensive patients with or without DM had depressed LV function compared with the controls, but there was no difference between the hypertensive patients with or without DM. DM does not seem to have additive adverse effects on the LV long axis and midwall function in persons with hypertension.

Keyword

Diabetes mellitus; Hypertension; Ventricular function, Left; Echocardiography

MeSH Terms

Axis, Cervical Vertebra
Blood Pressure
Diabetes Mellitus
Echocardiography
Humans
Hypertension
Risk Factors
Supine Position
Ventricular Function, Left

Reference

1. Gress TW, Nieto FJ, Shahar E, Wofford MR, Brancati FL. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. N Engl J Med. 2000. 342:905–912.
Article
2. Fox CS, Coady S, Sorlie PD, D'Agostino RB Sr, Pencina MJ, Vasan RS, et al. Increasing cardiovascular disease burden due to diabetes mellitus: the Framingham Heart Study. Circulation. 2007. 115:1544–1550.
Article
3. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005. 112:e154–e235.
4. Devereux RB, Roman MJ, Paranicas M, O'Grady MJ, Lee ET, Welty TK, et al. Impact of diabetes on cardiac structure and function: the strong heart study. Circulation. 2000. 101:2271–2276.
Article
5. Asbun J, Villarreal FJ. The pathogenesis of myocardial fibrosis in the setting of diabetic cardiomyopathy. J Am Coll Cardiol. 2006. 47:693–700.
Article
6. Fouad FM, Slominski JM, Tarazi RC. Left ventricular diastolic function in hypertension: relation to left ventricular mass and systolic function. J Am Coll Cardiol. 1984. 3:1500–1506.
Article
7. Frohlich ED, Apstein C, Chobanian AV, Devereux RB, Dustan HP, Dzau V, et al. The heart in hypertension. N Engl J Med. 1992. 327:998–1008.
Article
8. Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996. 275:1557–1562.
Article
9. Di Bonito P, Moio N, Cavuto L, Covino G, Murena E, Scilla C, et al. Early detection of diabetic cardiomyopathy: usefulness of tissue Doppler imaging. Diabet Med. 2005. 22:1720–1725.
Article
10. Wang M, Yip GW, Wang AY, Zhang Y, Ho PY, Tse MK, et al. Tissue Doppler imaging provides incremental prognostic value in patients with systemic hypertension and left ventricular hypertrophy. J Hypertens. 2005. 23:183–191.
Article
11. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986. 57:450–458.
Article
12. de Simone G, Ganau A, Roman MJ, Devereux RB. Relation of left ventricular longitudinal and circumferential shortening to ejection fraction in the presence or in the absence of mild hypertension. J Hypertens. 1997. 15:1011–1017.
Article
13. de Simone G, Devereux RB, Roman MJ, Ganau A, Saba PS, Alderman MH, et al. Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension. J Am Coll Cardiol. 1994. 23:1444–1451.
Article
14. de Simone G, Devereux RB, Koren MJ, Mensah GA, Casale PN, Laragh JH. Midwall left ventricular mechanics. An independent predictor of cardiovascular risk in arterial hypertension. Circulation. 1996. 93:259–265.
15. Quinones MA, Gaasch WH, Cole JS, Alexander JK. Echocardiographic determination of left ventricular stress-velocity relations. Circulation. 1975. 51:689–700.
Article
16. Reichek N, Wilson J, St John Sutton M, Plappert TA, Goldberg S, Hirshfeld JW. Noninvasive determination of left ventricular end-systolic stress: validation of the method and initial application. Circulation. 1982. 65:99–108.
Article
17. Casale PN, Devereux RB, Milner M, Zullo G, Harshfield GA, Pickering TG, et al. Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men. Ann Intern Med. 1986. 105:173–178.
Article
18. Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med. 1991. 114:345–352.
Article
19. Devereux RB, de Simone G, Ganau A, Roman MJ. Left ventricular hypertrophy and geometric remodeling in hypertension: stimuli, functional consequences and prognostic implications. J Hypertens Suppl. 1994. 12:Suppl. S117–S127.
20. de Simone G, Gottdiener JS, Chinali M, Maurer MS. Left ventricular mass predicts heart failure not related to previous myocardial infarction: the Cardiovascular Health Study. Eur Heart J. 2008. 29:741–747.
Article
Full Text Links
  • CMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr