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Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

  • Autori: Nardi, E; Palermo, A; Mule', G; Cusimano, P; Cottone, S; Cerasola, G.
  • Anno di pubblicazione: 2011
  • Tipologia: Articolo in rivista (Articolo in rivista)
  • Parole Chiave: left ventricular hypertrophy; diabetes; chronic kidney disease; diastolic dysfunction; heart diseases
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Left ventricular hypertrophy (LVH) and diastolic dysfunction are very common in patients with chronic kidney disease (CKD). Aim of this study was to evaluate the impact of type 2 diabetes on LV geometry and diastolic function in hypertensive patients with CKD. We enrolled 288 Caucasian subjects with hypertension and CKD; of them, 112 had diabetes. Patients with cardiovascular (CV) diseases, glomerular filtration rate (GFR)> 60 m/min per 1.73m2, dialysis treatment and other major non-CV diseases were excluded. All patients underwent routine biochemical analyses and echocardiographic examination with tissue Doppler imaging (TDI). Patients with diabetes had significantly higher LV wall thicknesses (P<0.0001), relative wall thickness (RWT)(P<0.0001) and left atrium volume index (P<0.03),when compared with patients without diabetes. Further, diabetic patients had very high prevalence of concentric LVH. Em, evaluated by TDI, was significantly lower in patients with diabetes (P<0.005). However, the difference lost statistical significance after correction by analysis of covariance for RWT. Multiple stepwise linear regression analysis showed that the variables independently associated with Em were: age (b 0.364; P¼0.0001), GFR (beta 0.101; P<0.019), and the presence of diabetes (b 0.166; P<0.002). Our study showed that in hypertensive patients with CKD the presence of diabetes is associated with increased LV-wall thicknesses and concentric geometry; further, diabetes together with renal function (GFR) is associated with worse diastolic function, independently of potential confounders, such as age, gender, body mass index and blood pressure