Left Ventricular Diastolic Dysfunction in Diabetes.832
1
Design and Method: 386 patients with TDM1 aged from 5 to 18 years old from three different regions of Russian Federation were examined in the course of screening programs. Average duration of TDM1 was 2,81 year. The level of HbA1 and microalbuminuria (MAU) were measured on Bayer DCA 2000þ analyzer. The ophthalmoscopy was performed by direct view method. The technique of blood pressure (BP) measurement was standardized. Statistical analysis was performed with -square criteria and Mann-Whitney test. Results: Children and adolescents with T1DM had BP level more higher than the same rate in healthy children for equal aging group. 21 % of children with T1DM had a systolic blood pressure (SBP) on 95 % for aging standard (p ¼ 0,004). Diastolic blood pressure (DBP) levels were not significantly different. During ophthalmoscopy the retinopathy was diagnosed in 12% of patients, 1,1 % of adolescents had proliferative retinopathy at the duration of T1DM more than 5 years. MAU was not indicated as neither children nor adolescents. Median of HbA1 level in adolescents was on 1,6% in excess of prepubertal children (9,8% vs 8,25%, p < 0,001), that indicate on pure metabolic control in group of adolescents and high risk of microangiopathies development. Conclusions: SBP in diabetes children is an effective marker of early development of retinopathy. Retinopathy and high SBP were combined more frequently in adolescents with poor metabolic control. PP.17.146 INTRARENAL BLOOD FLOW DOPPLER SPECTRA IN DIABETIC PATIENTS AND HYPERTENSIVE DIABETIC PATIENTS O. Koshelskaya, R. Karpov. Institute of Cardiology, Tomsk, Russia Objectives: The aim of the study was to determine the changes of Doppler spectra indices of intrarenal blood flow in diabetic patients with/without hypertension; to compare the changes of intrarenal vascular resistance in hypertensive diabetic patients with/without microalbuminuria. Methods: The 28 diabetic patients (Gr.D), 52 hypertensive patients (Gr.H), 208 diabetic hypertensive patients (Gr.HD) and 14 healthy people (control group). were included. The were no differences between the hypertensive groups in sex, age, BP-24 h levels and duration of arterial hypertension. Renal blood flow velocities profiles were detected by duplex scanning index in renal and arcuate intrarenal arteries; on the grounds of which resistive index in the segmental (RIs) and arcuate intrarenal arteries (RIar) was calculated. 24-hour ambulatory BP recordings were performed. Serum insulin concen- tration were measured by radioimmune method. 24-hour urinary protein excretion was determined by standart laboratory method. Results: 34,1% diabetic hypertensive patients, 13,3% hypertensive patients (P ¼ 0,0005 vs Gr.HD) and 7,7% diabetic patients (P ¼ 0,0245 vs Gr.HD) have microalbuminuria. Even normotensive diabetic patients show an increase in intrarenal vascular resistance: RIar levels were 0,63 0,05 and 0,59 0,04 in Gr.D vs 0,54 0,06 and 0,48 0,02 in the control group, respectively. Compared with pts of Gr.H, in pts of Gr.HD was observed more marked increase in intrarenal vascular resistance: RIar levels were 0,60 0,05 in Gr.HD vs 0,57 0,06 in Gr.H. In pts with microalbuminuria, the elevated indices of intrarenal vascular resistance were positively associ- ated with duration of hypertension, age, levels of HbA1, triglycerides, total cholesterol and negatively associated with decrease in diastolic BP-day, diastolic BP-24 h and duration of diastolic arterial hypertension during daytime at disproportional increase in systolic BP. Conclusions: Our results show that the increase in intrarenal resistance is developed at earlier stages of diabetes. Hypertensive diabetic patients developed the increase in intrarenal resistance and/or microalbuminuria earlier as compared to hypertensive patients without diabetes. PP.17.147 LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN DIABETES MELLITUS TYPE 2 T. Exiara 1 , A. Konstantis 1 , L. Papazoglou 2 , M. Kouroupi 3 , A. Kalpaka 4 , L. Mporgi 5 , A. Risggits 5 , E. Filippidou 3 , S. Terzi 5 , S. Papanastasiou 1 . 1 General Hospital Sismanoglio-Department of Internal Medicine, Komotini, Greece, 2 Military Hospital of Alexandroupolis-Department of Internal Medicine, Alexan- droupolis, Greece, 3 University Hospital Democritus University of Thrace-Depart- ment of Internal Medicine, Alexandroupolis, Greece, 4 General Hospital Agios Pavlos-Department of Internal Medicine, Thessaloniki, Greece, 5 General Hospital Sismanoglio-Department of Cardiology, Komotini, Greece Objectives: Diabetes mellitus (DM) is a major risk factor for the develop- ment of heart failure. Diastolic heart failure (DHF) is a clinical syndrome characterized by a preserved systolic function and abnormal diastolic func- tion. The prevalence of asymptomatic DHF was estimated in 27% in the general population. Left ventricular diastolic dysfunction (LVDD) has been described as an early preclinical manifestation of a specific cardiomyopathy in patients with DM without hypertension and known coronary artery disease. The aim of this study was to determine the prevalence of LVDD in a normotensive population with well-controlled DM type 2 and without signs and symptoms of DHF. Design-Methods: 114 outpatients with DM type 2, 48(42.1%) male and 66(57.9%) female with mean age of 44 8.2 years, were enrolled in this study. All patients were normotensive with well-controlled diabetes (HbA1c<6.5), without evidence of heart failure, coronary artery disease, thyroid or overt renal disease and with normal electrocardiogram and thoracic x-ray. All patients underwent Doppler echocardiography by a single experience cardiologist with use the Valsalva maneuver on analysis of mitral flow. The diagnosis of LVDD has been according to the criteria of Heart Failure and Echocardiography Associations of the European Society of Cardiology. Results: A total of 62(63.2%) patients, 23 male (49.7% of men) and 39 female (59.1% of women) had LVDD. 48(77.4%) patients had impaired relaxation pattern of LVDD, 14(22.6%) had pseudonormal pattern and no one had restrictive pattern of LVDD. Female gender and duration of diabetes had positive correlation with the presence of LVDD. Parameters of metabolic syndrome had no correlation with LVDD. The presence of LVDD increased according to increasing age. Conclusion: In our study, the prevalence of LVDD in normotensive, asymptomatic and well-controlled patients with DM type 2 is high. Mild LVDD may be the first stage of diabetic cardiomyopathy. Patients with DM type 2 maybe must screening for sub clinical LVDD by echocardiography. PP.17.148 USEFULNESS OF 75G GLUCOSE TOLERANCE TEST FOR DETECTION OF IMPAIRED GLUCOSE TOLERANCE IN HYPERTENSIVE PATIENTS H. Takase 1 , Y. Dohi 2 , T. Toriyama 1 , T. Okado 1 , H. Sonoda 1 , A. Hagikura 1 , G. Kimura 2 . 1 Enshu Hospital - Department of Internal Medicine, Hamamatsu, Japan, 2 Nagoya City University Graduate School of Medical Sciences - Department of Cardio-Renal Medicine and Hypertension, Nagoya, Japan Objective: Diagnosis of impaired glucose tolerance (IGT) is important in patients with hypertension, because IGT often coexists with hypertension and markedly increases cardiovascular risk in hypertensive individuals. The present study was designed to investigate usefulness of glucose tolerance test (GTT), as compared to fasting plasma glucose (FPG) levels, in the evaluation of glucose metabolism in hypertensive patients. Design and Method: We enrolled consecutive 7,012 participants in our physical check-up program without anti-diabetic medications (1,957 hyper- tension; 5,055 normotension). First, glucose metabolism was assessed using FPG. Second, among participants who had normal FPG levels, 333 partici- pants were randomly selected and underwent 75 g GTT. Results: The results are shown in the Table. The prevalence of IGT or diabetes mellitus (DM) was about double in participants with hypertension as compared to normotensive participants. Strikingly, about 30% and 20% of hypertensive and normotensive participants, respectively, with normal FPG showed disorder of glucose metabolism in GTT. Conclusions: GTT is a useful and sensitive method to identify IGT or DM, while FPG may not be adequate for this purpose. GTT should be used for accurate detection of IGT or DM, especially in high risk population such as hypertension. e294 Journal of Hypertension Vol 28, e-Supplement A, June 2010
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Transcript of Left Ventricular Diastolic Dysfunction in Diabetes.832
-
Design and Method: 386 patients with TDM1 aged from 5 to 18 years oldfrom three different regions of Russian Federation were examined in thecourse of screening programs. Average duration of TDM1 was 2,81 year. Thelevel of HbA1 and microalbuminuria (MAU) were measured on Bayer DCA2000 analyzer. The ophthalmoscopy was performed by direct view method.The technique of blood pressure (BP) measurement was standardized.Statistical analysis was performed with -square criteria and Mann-Whitneytest.
Results: Children and adolescents with T1DM had BP level more higherthan the same rate in healthy children for equal aging group. 21 % of childrenwith T1DM had a systolic blood pressure (SBP) on 95 % for aging standard(p 0,004). Diastolic blood pressure (DBP) levels were not significantlydifferent. During ophthalmoscopy the retinopathy was diagnosed in 12% ofpatients, 1,1 % of adolescents had proliferative retinopathy at the duration ofT1DM more than 5 years. MAU was not indicated as neither children noradolescents. Median of HbA1 level in adolescents was on 1,6% in excess ofprepubertal children (9,8% vs 8,25%, p< 0,001), that indicate on puremetabolic control in group of adolescents and high risk of microangiopathiesdevelopment.
Conclusions: SBP in diabetes children is an effective marker of earlydevelopment of retinopathy. Retinopathy and high SBP were combinedmore frequently in adolescents with poor metabolic control.
PP.17.146 INTRARENAL BLOOD FLOW DOPPLER SPECTRA INDIABETIC PATIENTS AND HYPERTENSIVE DIABETICPATIENTS
O. Koshelskaya, R. Karpov. Institute of Cardiology, Tomsk, Russia
Objectives: The aim of the study was to determine the changes of Dopplerspectra indices of intrarenal blood flow in diabetic patients with/withouthypertension; to compare the changes of intrarenal vascular resistance inhypertensive diabetic patients with/without microalbuminuria.
Methods: The 28 diabetic patients (Gr.D), 52 hypertensive patients (Gr.H),208 diabetic hypertensive patients (Gr.HD) and 14 healthy people (controlgroup). were included. The were no differences between the hypertensivegroups in sex, age, BP-24 h levels and duration of arterial hypertension. Renalblood flow velocities profiles were detected by duplex scanning index inrenal and arcuate intrarenal arteries; on the grounds of which resistive indexin the segmental (RIs) and arcuate intrarenal arteries (RIar) was calculated.24-hour ambulatory BP recordings were performed. Serum insulin concen-tration were measured by radioimmune method. 24-hour urinary proteinexcretion was determined by standart laboratory method.
Results: 34,1% diabetic hypertensive patients, 13,3% hypertensive patients(P 0,0005 vs Gr.HD) and 7,7% diabetic patients (P 0,0245 vs Gr.HD)have microalbuminuria. Even normotensive diabetic patients show anincrease in intrarenal vascular resistance: RIar levels were 0,63 0,05 and0,59 0,04 in Gr.D vs 0,54 0,06 and 0,48 0,02 in the control group,respectively. Compared with pts of Gr.H, in pts of Gr.HD was observedmore marked increase in intrarenal vascular resistance: RIar levels were0,60 0,05 in Gr.HD vs 0,57 0,06 in Gr.H. In pts with microalbuminuria,the elevated indices of intrarenal vascular resistance were positively associ-ated with duration of hypertension, age, levels of HbA1, triglycerides, totalcholesterol and negatively associated with decrease in diastolic BP-day,diastolic BP-24 h and duration of diastolic arterial hypertension duringdaytime at disproportional increase in systolic BP.
Conclusions: Our results show that the increase in intrarenal resistance isdeveloped at earlier stages of diabetes. Hypertensive diabetic patientsdeveloped the increase in intrarenal resistance and/or microalbuminuriaearlier as compared to hypertensive patients without diabetes.
PP.17.147 LEFT VENTRICULAR DIASTOLIC DYSFUNCTION INDIABETES MELLITUS TYPE 2
T. Exiara1, A. Konstantis1, L. Papazoglou2, M. Kouroupi3, A. Kalpaka4,L. Mporgi5, A. Risggits5, E. Filippidou3, S. Terzi5, S. Papanastasiou1.1General Hospital Sismanoglio-Department of Internal Medicine, Komotini, Greece,2Military Hospital of Alexandroupolis-Department of Internal Medicine, Alexan-droupolis, Greece, 3University Hospital Democritus University of Thrace-Depart-ment of Internal Medicine, Alexandroupolis, Greece, 4General Hospital AgiosPavlos-Department of Internal Medicine, Thessaloniki, Greece, 5General HospitalSismanoglio-Department of Cardiology, Komotini, Greece
Objectives: Diabetes mellitus (DM) is a major risk factor for the develop-ment of heart failure. Diastolic heart failure (DHF) is a clinical syndromecharacterized by a preserved systolic function and abnormal diastolic func-
tion. The prevalence of asymptomatic DHF was estimated in 27% in thegeneral population. Left ventricular diastolic dysfunction (LVDD) has beendescribed as an early preclinical manifestation of a specific cardiomyopathyin patients with DM without hypertension and known coronary arterydisease.
The aim of this study was to determine the prevalence of LVDD in anormotensive population with well-controlled DM type 2 and without signsand symptoms of DHF.
Design-Methods: 114 outpatients with DM type 2, 48(42.1%) male and66(57.9%) female with mean age of 44 8.2 years, were enrolled in thisstudy. All patients were normotensive with well-controlled diabetes(HbA1c
