1. Coronary Artery Disease Is a Strong Determinant of Left Ventricular Stiffness in Subjects with the Metabolic Syndrome and Type 2 Diabetes.
- Author
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Diamant, Michaela, de Leth, Richard, Tushuizen, Maarten E., Vlasblom, Ronald, and Paulus, Walter J.
- Subjects
DIAGNOSIS ,CORONARY disease ,LEFT heart ventricle ,TYPE 2 diabetes ,METABOLIC syndrome ,CONGESTIVE heart failure ,PEOPLE with diabetes ,ARTERIAL stenosis ,DIASTOLE (Cardiac cycle) - Abstract
Type 2 diabetes (DM2) and the metabolic syndrome (MetS) are conditions associated with a high risk of coronary artery disease (CAD) and congestive heart failure (CHF). Although CAD contributes to diastolic dysfunction and left ventricular (LV) stiffness, the interaction between CAD, DM2 and the MetS, is largely unknown. We studied the impact of CAD, DM2 and the MetS on LV function and stiffness in patients who underwent a diagnostic coronary angiography. Sixty patients (n=22 with and n=21 without the MetS and n=17 with DM2; n=38 males were studied. Only subjects with LV ejection fraction >40% were included to avoid the confounding of post myocardial infarction remodeling. CAD severity was determined according to the number of the vessels with >50% stenosis. Thus, 26 patients had no CAD, 14 had 1, 9 had 2, 11 had 3 vessel disease. Hemodynamic and echocardiographic data were collected and combined to calculate percent LV wall thickening (LVWT%), a measure of systolic function, as well as LV end-diastolic wall thickness (LVWTed) and myocardial stiffness modulus, both variables of diastolic function. LVWT% did not differ among groups. DM2 subjects and those with the MetS had higher LVWTed than controls (P=0.019), but LV stiffness was not increased. Patients with vs those without CAD had higher LVWTed (P=0.022) and lower LVWT% (P=0.031). A trend for increased LV stiffness in CAD patients was observed (P=0.158). LV stiffness worsened according to the number of vessels involved (P=0.044). Multivariate analyses revealed CAD as an independent determinant of LV stiffness, after correction for age, gender and fasting glucose, in patients with MetS and DM2 (P=0.002), but not in controls (P=0.895). In conclusion, increased LVWTed was observed in subjects with the MetS and DM2, vs controls, and in patients with relative to those without CAD. We show that the contribution of CAD to LV stiffness depends on the presence of dysmetabolic conditions including the MetS and DM2. These findings implicate that strategies aiming early detection and treatment of CAD in people with MetS and DM2 may prevent future development of CHF. [ABSTRACT FROM AUTHOR]
- Published
- 2007