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Cardiovascular and metabolic risk
Left ventricular chamber dilation and filling pressure may help to categorise patients with type 2 diabetes
  1. Giacomo Zoppini1,
  2. Corinna Bergamini2,
  3. Stefano Bonapace3,
  4. Maddalena Trombetta1,
  5. Alessandro Mantovani1,
  6. Anna Toffalini1,
  7. Laura Lanzoni3,
  8. Lorenzo Bertolini4,
  9. Luciano Zenari4,
  10. Enzo Bonora1,
  11. Giovanni Targher1,
  12. Andrea Rossi2
  1. 1 Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
  2. 2 Department of Medicine, Section of Cardiology, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
  3. 3 Division of Cardiology, ‘Sacro Cuore’ Hospital, Negrar, Italy
  4. 4 Division of General Medicine and Diabetes Unit, ‘Sacro Cuore’ Hospital, Negrar, Italy
  1. Correspondence to Dr Giacomo Zoppini; giacomo.zoppini{at}univr.it

Abstract

Background Type 2 diabetes may alter cardiac structure and function. Many patients with type 2 diabetes have diastolic dysfunction with preserved ejection fraction (EF). Recently, this latter measure was criticised. Thus, this research looked at the impact of left ventricular end-diastolic volume and E/e′ ratio variations in patients with type 2 diabetes and preserved EF with the aim to recognise different clinical phenotypes.

Methods In this cross-sectional study, we evaluated 176 men affected by type 2 diabetes with transthoracic echocardiography. All subjects have preserved EF (>50%). Patients were stratified into four groups based on the median value of both left ventricular end-diastolic volume and E/e′ ratio, and the clinical variables were registered. The independent predictors associated with the groups were analysed by a multinomial logistic regression model.

Results Diabetes duration, age, estimated glomerular filtration rate and antihypertensive treatments were significantly different among the groups as were EF, left atrial volume index (LAVI), E/A, septum thickness and s′ mean wave. Multinomial regression analysis showed that the groups significantly differed for age, diabetes duration, EF, LAVI, septum thickness and s′ mean wave. The main result of this study was that patients with higher left ventricular volume and higher E/e′ ratio (group 2) showed the worse clinical profile.

Conclusions Our study might suggest that variations of left ventricular end-diastolic volume along with E/e′ ratio variations, even in the normal range, may allow to recognise phenotypes of patients with type 2 diabetes with worse clinical characteristics. This finding should be tested in prospective studies to assess the predictive roles of these phenotypes.

  • type 2 diabetes
  • transthoracic echocardiography
  • left ventricular geometry
  • preserved ejection fraction
  • chamber volume.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjdrc-2018-000529

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    Footnotes

    • Contributors GZ, GT, CB: conception, design and analysis and interpretation of data. GZ: drafting the manuscript. GT, SB, CB, AR, EB: revising critically the manuscript for important intellectual content. MT, LL, AM, LB, LZ, AT: contributed to the analysis and interpretation of data.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The local ethics committee approved the study protocol.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data generated or analysed during this study are included in this published article.