Juri Park and Jin-Seok Kim have contributed equally to this paper and should be considered joint first authors
Subclinical left ventricular (LV) diastolic dysfunction in type 2 diabetes (T2D) is a common finding and represents an early sign of diabetic cardiomyopathy. However, the relationship between LV diastolic dysfunction and the incident T2D has not been previously studied.
A total of 1817 non-diabetic participants (mean age, 54 years; 48% men) from the Korean Genome and Epidemiology Study who were free of cardiovascular disease were studied. LV structure and function were assessed by conventional echocardiography and tissue Doppler imaging. Subclinical LV diastolic dysfunction was defined using age-specific cutoff limits for early diastolic (Em) velocity, mitral E/Em ratio, and left atrial volume index.
During the 6-year follow-up period, 273 participants (15%) developed T2D. Participants with incident T2D had greater LV mass index (86.7 ± 16.4 vs. 91.2 ± 17.0 g/m2), worse diastolic function, reflected by lower Em velocity (7.67 ± 1.80 vs. 7.47 ± 1.70) and higher E/Em ratio (9.19 ± 2.55 vs. 10.23 ± 3.00), and higher prevalence of LV diastolic dysfunction (34.6 vs. 54.2%), compared with those who did not develop T2D (all P < 0.001). In a multivariate logistic regression model, lower Em velocity (odd ratio [OR], 0.867; 95% confidence interval [CI] 0.786–0.957) and the presence of LV diastolic dysfunction (OR, 1.617; 95% CI 1.191–2.196) were associated with the development of T2D, after adjusting for potential confounding factors.
In a community-based cohort, the presence of subclinical LV diastolic dysfunction was a predictor of the progression to T2D. These data suggest that the echocardiographic assessment of LV diastolic function may be helpful in identifying non-diabetic subjects at risk of incident T2D.
Standards of Medical Care in Diabetes-2016: summary of revisions. Diabetes Care. 2016;39 Suppl 1: S4–5.
Yoshida M, Mita T, Yamamoto R, Shimizu T, Ikeda F, Ohmura C, Kanazawa A, Hirose T, Kawamori R, Watada H. Combination of the Framingham risk score and carotid intima-media thickness improves the prediction of cardiovascular events in patients with type 2 diabetes. Diabetes Care. 2012;35:178–80. CrossRefPubMed
Anand DV, Lim E, Hopkins D, Corder R, Shaw LJ, Sharp P, Lipkin D, Lahiri A. Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy. Eur Heart J. 2006;27:713–21. CrossRefPubMed
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–70. CrossRefPubMed
Poulsen MK, Henriksen JE, Dahl J, Johansen A, Gerke O, Vach W, Haghfelt T, Høilund-Carlsen PF, Beck-Nielsen H, Møller JE. Left ventricular diastolic function in type 2 diabetes mellitus: prevalence and association with myocardial and vascular disease. Circ Cardiovasc Imaging. 2010;3:24–31. CrossRefPubMed
Cassidy S, Hallsworth K, Thoma C, MacGowan GA, Hollingsworth KG, Day CP, Taylor R, Jakovljevic DG, Trenell MI. Cardiac structure and function are altered in type 2 diabetes and non-alcoholic fatty liver disease and associate with glycemic control. Cardiovasc Diabetol. 2015;14:23. CrossRefPubMedPubMedCentral
Kawata T, Daimon M, Miyazaki S, Ichikawa R, Maruyama M, Chiang SJ, Ito C, Sato F, Watada H, Daida H. Coronary microvascular function is independently associated with left ventricular filling pressure in patients with type 2 diabetes mellitus. Cardiovasc Diabetol. 2015;14:98. CrossRefPubMedPubMedCentral
Zoppini G, Bonapace S, Bergamini C, Rossi A, Trombetta M, Lanzoni L, Bertolini L, Zenari L, Bonora E, Targher G. Evidence of left atrial remodeling and left ventricular diastolic dysfunction in type 2 diabetes mellitus with preserved systolic function. Nutr Metab Cardiovasc Dis. 2016;26:1026–32. CrossRefPubMed
Wang Y, Hou D, Ma R, Ding G, Yin L, Zhang M. Early detection of left atrial energy loss and mechanics abnormalities in diabetic patients with normal left atrial size: a study combining vector flow mapping and tissue tracking echocardiography. Med Sci Monit. 2016;22:958–68. CrossRefPubMedPubMedCentral
Milwidsky A, Maor E, Kivity S, Berkovitch A, Zekry SB, Tenenbaum A, Fisman EZ, Erez A, Segev S, Sidi Y, et al. Impaired fasting glucose and left ventricular diastolic dysfunction in middle-age adults: a retrospective cross-sectional analysis of 2971 subjects. Cardiovasc Diabetol. 2015;14:119. CrossRefPubMedPubMedCentral
Mostaza JM, Lahoz C, Salinero-Fort MA, de Burgos-Lunar C, Laguna F, Estirado E, García-Iglesias F, González-Alegre T, Cornejo-Del-Río V, Sabín C, et al. Carotid atherosclerosis severity in relation to glycemic status: a cross-sectional population study. Atherosclerosis. 2015;242:377–82. CrossRefPubMed
Kishi S, Gidding SS, Reis JP, Colangelo LA, Venkatesh BA, Armstrong AC, Isogawa A, Lewis CE, Wu C, Jacobs DR Jr, et al. Association of insulin resistance and glycemic metabolic abnormalities with LV structure and function in middle age: the CARDIA study. JACC Cardiovasc Imaging. 2017;10:105–14. CrossRefPubMed
- Subclinical left ventricular diastolic dysfunction and incident type 2 diabetes risk: the Korean Genome and Epidemiology Study
Seong Hwan Kim
Sang Yup Lim
Kwang Kon Koh
Jung Bok Lee
Seung Ku Lee
- BioMed Central
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