| ǥ :
|
ȣ - 480292 178 |
| Microalbuminuria is an independent risk factor for myocardial dysfunction assessed with strain and strain rate imaging in patients with diabetes mellitus. |
| Cardiology Division¹ , Yonsei Cardiovascular Center and Cardiovascular Research Institute², Department of Internal medicine ³, Yonsei University College of Medicine, Seoul, South Korea |
| Chi Young Shim, MD¹, Seong-Hoon Choi, MD¹ , Won-Ho Kim, MD¹. Jin-Bae Kim¹ . Ji-Young Kim, RDCS¹, Seok-Min Kang, MD¹ ², Bong-Soo Cha, MD³,Jong-Won Ha, MD ¹ ², Se-Joong Rim, MD¹ ², Namsik Chung, MD¹ ² |
Background: Albuminuria is an independent cardiovascular risk factor in diabetic patients but the association with intrinsic myocardial dysfunction is unclear. The aim of this study was to examine the relationship of albuminuria to myocardial dysfunction in diabetes mellitus using strain and strain rate imaging, sensitive markers of systolic performance.
Methods: Forty-two patients (27 patients with type II diabetes mellitus and hypertension, 15 patients with hypertension only) were enrolled prospectively. All patients had normal ejection fraction (LVEF>55%). Patients with left ventricular hypertrophy or coronary artery disease(confirmed by treadmill ECG or setamibi scan) were excluded. On albuminuria status, diabetes patients were divided into three groups.: Group II = no albuminuria( n=12, <30 mg/day); Group III = microalbuminuria ( n=8, 30 to 300 mg/day); and Group IV = macroalbuminuria ( n=7, >300 mg/day). Fifteen poatients with hypertension only served as a control group(Group I). Peak strain and strain rate of six walls in apical views were measured and averaged in each patient.
Results: Echocardiographic parameters such as LVEF, LA size, LVEDD, LVESD, LV wall thickness, LV mass, E velocity, A velocity, E' velocity and A' velocity were not different amoing four groups. Peak strains were significantly lower in group III(19.55±1.24%, p=0.002) and group IV (17.36±1.90%, p<0.001) than group I(23.15±1.91%). There was no significant deference between group I and II (23.15±1.91% vs. 21.25±3.33%, p=0.41). The degree of albuminuria negatively correlated with peak strain (R2=0.217, p=0.002). Absolute value of strain rates were lower in group III(-1.44±0.27 s-1, p=0.033) and group IV(-1.11±1.19 s-1, p<0.001) than group I(-1.58±0.30 s-1).There was no significant deference between group I and II (-1.58±0.30 s-1 vs. -1.50±0.29 s-1, p=0.71). The degree of albuminuria correlated with strain rate ( R2=0.122, p=0.022).
Conclusions: In diabetes patients without overt heart disease, albuminuria is independently associated with early LV systolic dysfunction.
|
|
|
|
|
