Key result
Type 2 diabetes in hemodialysis patients was associated with advanced left ventricular diastolic dysfunction, evidenced by a higher estimated filling pressure (average E/e' 14.5 vs 12.4, P=0.011).
Why the study?
Does the presence of type 2 diabetes mellitus worsen left ventricular diastolic function in ESRD patients on maintenance hemodialysis?
Cross-Sectional (n=101)
No
Does the presence of type 2 diabetes mellitus worsen left ventricular diastolic function in ESRD patients on maintenance hemodialysis?
Absolute Event Rate: 14.5% vs 12.4%
p-value: p=0.011
Tissue Doppler imaging reveals that ESRD patients with type 2 diabetes on hemodialysis have more advanced left ventricular diastolic dysfunction compared to those without diabetes, despite normal systolic function.
May support closer monitoring in diabetic hemodialysis patients; leaves open causality and need for prospective validation.
BACKGROUND: Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD). Myocardial dysfunction may occur in patients with diabetes mellitus (DM) in the absence of coronary artery disease or left ventricular (LV) hypertrophy. Although tissue Doppler imaging (TDI) is a highly effective means of quantifying myocardial diastolic function, its differences in ESRD patients with diabetes and without diabetes remain unclear. METHODS AND RESULTS: A total of 101 ESRD patients on maintenance hemodialysis with normal LV systolic function were studied: 37 with type 2 DM and 64 without DM. Conventional echocardiography and TDI were performed to evaluate LV systolic and diastolic functions. The conventional LV systolic and diastolic echocardiographic parameters did not differ according to presence of DM, except for the left atrial size and volume index (P<0.001). The ESRD patients with DM, however, had significantly decreased mitral annular early diastolic peak velocity (e') and ratio of early to late diastolic mitral annular velocity (e'/a'; both P<0.02). Additionally, the group with DM had markedly higher estimated LV end-diastolic filling pressure (E/e'; P=0.011). CONCLUSIONS: ESRD patients with DM had advanced LV diastolic dysfunction on TDI. In ESRD patients with DM, diabetic cardiomyopathy associated with advanced LV diastolic dysfunction is observed. (Circ J 2012; 76: 2380-2385).
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Hung et al. (2012) conducted a cross-sectional in End-stage renal disease on maintenance hemodialysis (n=101). Type 2 Diabetes Mellitus vs. Without Type 2 Diabetes Mellitus was evaluated on Estimated left ventricular end-diastolic filling pressure (average E/e') (p=0.011). Type 2 diabetes in hemodialysis patients was associated with advanced left ventricular diastolic dysfunction, evidenced by a higher estimated filling pressure (average E/e' 14.5 vs 12.4, P=0.011).
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