PMID- 20950415
OWN - NLM
STAT- MEDLINE
DCOM- 20110203
LR  - 20221207
IS  - 1475-2840 (Electronic)
IS  - 1475-2840 (Linking)
VI  - 9
DP  - 2010 Oct 15
TI  - Insulin resistance and glycemic abnormalities are associated with deterioration 
      of left ventricular diastolic function: a cross-sectional study.
PG  - 63
LID - 10.1186/1475-2840-9-63 [doi]
AB  - BACKGROUND: Left ventricular diastolic dysfunction (LVDD) is considered a 
      precursor of diabetic cardiomyopathy, while insulin resistance (IR) is a 
      precursor of type 2 diabetes mellitus (T2DM) and independently predicts heart 
      failure (HF). We assessed whether IR and abnormalities of the glucose metabolism 
      are related to LVDD. METHODS: We included 208 patients with normal ejection 
      fraction, 57 (27%) of whom had T2DM before inclusion. In subjects without T2DM, 
      an oral glucose tolerance test (oGTT) was performed. IR was assessed using the 
      Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). The lower limit of 
      the top quartile of the HOMA-IR distribution (3.217) was chosen as threshold for 
      IR. LVDD was verified according to current guidelines. RESULTS: IR was diagnosed 
      in 38 (18%) patients without a history of diabetes. The prevalence of LVDD was 
      92% in subjects with IR vs. 72% in patients without IR (n = 113), respectively (p 
      = 0.013). In the IR group, the early diastolic mitral inflow velocity (E) in 
      relation to the early diastolic tissue Doppler velocity (averaged from the septal 
      and lateral mitral annulus, E'av) ratio (E/E'av) was significantly higher 
      compared to those without IR (9.8 [8.3-11.5] vs. 8.1 [6.6-11.0], p = 0.011). This 
      finding remains significant when patients with IR and concomitant T2DM based on 
      oGTT results were excluded (E/E'av ratio 9.8 [8.2-11.1)] in IR vs. 7.9 [6.5-10.5] 
      in those without both IR and T2DM, p = 0.014). There were significant differences 
      among patients with and without LVDD regarding the HOMA-IR (1.71 [1.04-3.88] vs. 
      1.09 [0.43-2.2], p = 0.003). The HOMA-IR was independently associated with LVDD 
      on multivariate logistic regression analysis, a 1-unit increase in HOMA-IR value 
      was associated with an odds ratio for prevalent LVDD of 2.1 (95% CI 1.3-3.1, p = 
      0.001). Furthermore, the E/E'av ratio increases along the glucose metabolism 
      status from normal glucose metabolism (7.6 [6.2-10.1]) to impaired glucose 
      tolerance (8.8 [7.4-11.0]) and T2DM (10.5 [8.1-13.2]), respectively (p < 0.001). 
      CONCLUSIONS: Insulin resistance is independently associated with LVDD in subjects 
      without overt T2DM. Patients with IR and glucose metabolism disorders might 
      represent a target population to prevent the development of HF. Screening 
      programs for glucose metabolism disturbances should address the assessment of 
      diastolic function and probably IR.
FAU - Dinh, Wilfried
AU  - Dinh W
AD  - Institute for Heart and Circulation Research, University Witten/Herdecke, 
      Germany. wilfried.dinh@helios-kliniken.de
FAU - Lankisch, Mark
AU  - Lankisch M
FAU - Nickl, Werner
AU  - Nickl W
FAU - Scheyer, Daniel
AU  - Scheyer D
FAU - Scheffold, Thomas
AU  - Scheffold T
FAU - Kramer, Frank
AU  - Kramer F
FAU - Krahn, Thomas
AU  - Krahn T
FAU - Klein, Rolf M
AU  - Klein RM
FAU - Barroso, Michael Coll
AU  - Barroso MC
FAU - Futh, Reiner
AU  - Futh R
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20101015
PL  - England
TA  - Cardiovasc Diabetol
JT  - Cardiovascular diabetology
JID - 101147637
RN  - 0 (Biomarkers)
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Insulin)
RN  - 0 (hemoglobin A1c protein, human)
SB  - IM
MH  - Aged
MH  - Biomarkers/blood
MH  - Blood Glucose/*analysis
MH  - Chi-Square Distribution
MH  - Cross-Sectional Studies
MH  - Diabetes Mellitus, Type 2/blood/*epidemiology/physiopathology
MH  - Diastole
MH  - Echocardiography, Doppler
MH  - Female
MH  - Germany/epidemiology
MH  - Glucose Tolerance Test
MH  - Glycated Hemoglobin/analysis
MH  - Humans
MH  - Insulin/blood
MH  - *Insulin Resistance
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Prevalence
MH  - Risk Assessment
MH  - Risk Factors
MH  - Stroke Volume
MH  - Ventricular Dysfunction, Left/diagnostic imaging/*epidemiology/physiopathology
MH  - *Ventricular Function, Left
PMC - PMC2964598
EDAT- 2010/10/19 06:00
MHDA- 2011/02/04 06:00
PMCR- 2010/10/15
CRDT- 2010/10/19 06:00
PHST- 2010/09/06 00:00 [received]
PHST- 2010/10/15 00:00 [accepted]
PHST- 2010/10/19 06:00 [entrez]
PHST- 2010/10/19 06:00 [pubmed]
PHST- 2011/02/04 06:00 [medline]
PHST- 2010/10/15 00:00 [pmc-release]
AID - 1475-2840-9-63 [pii]
AID - 10.1186/1475-2840-9-63 [doi]
PST - epublish
SO  - Cardiovasc Diabetol. 2010 Oct 15;9:63. doi: 10.1186/1475-2840-9-63.