Concomitant diabetes and chronic kidney disease in hypertensive patients independently predicted left ventricular diastolic dysfunction during passive leg lifting (DM OR 2.82, P<0.05).
Observational (n=155)
Does concomitant diabetes and/or chronic kidney disease affect preload-induced changes in left ventricular diastolic filling in asymptomatic essential hypertensive patients?
A simple preloading test using passive leg lifting unmasks latent progression of left ventricular diastolic dysfunction in hypertensive patients with concomitant diabetes or chronic kidney disease.
Odds Ratio: 2.82
p-value: p=<0.05
OBJECTIVES: Concomitant diabetes and/or chronic kidney disease (CKD) in hypertensive patients may portend additive deleterious effects on active left ventricular relaxation. We investigated the effect of a passive leg lifting (PLL) maneuver, a means of increasing preload, on left ventricular filling to assess the relationship of concomitant diabetes mellitus (DM) and/or CKD with diastolic function in hypertensive patients. METHODS: A total of 155 asymptomatic essential hypertensive patients underwent Doppler echocardiography to compare the echocardiographic indices at baseline and during PLL. In 51 patients, the effect of physiological saline infusion was also examined. RESULTS: The changes in echocardiographic indices, including deceleration time of early diastolic filling (EDT) and the ratio of transmitral early left ventricular filling velocity to early diastolic Doppler tissue imaging of the mitral annulus (E/E') by saline infusion showed a good correlation with those induced by PLL (Bland-Altman plot and linear regression). We next divided the total participants into four groups according to the presence/absence of diabetes and/or CKD DM(-)/CKD(-); n = 48, DM(+)/CKD(-); n = 25, DM(-)/CKD(+); n = 43, and DM(+)/CKD(+); n = 39) and found that the changes in EDT (F = 15.92, P < 0.01) as well as those in E/E' (F = 8.87, P < 0.01) were significantly different among the subgroups. Multiple logistic regression analysis revealed that these complications were independent predictors of EDT less than 150 ms DM, odds ratio (OR): 2.82; CKD, OR: 2.18, P < 0.05, respectively as well as E/E' ratio at least 15.0 during PLL (DM, OR: 4.78; CKD, OR: 3.32, P < 0.05, respectively). CONCLUSION: This simple preloading test unmasks latent progression of left ventricular dysfunction in essential hypertension; that is, these complications potentially cause deterioration of left ventricular compliance and preload reserve even in the early stages of diastolic dysfunction.
Iwashima et al. (Wed,) conducted a observational in essential hypertension (n=155). Concomitant diabetes mellitus and/or chronic kidney disease vs. Absence of diabetes and chronic kidney disease was evaluated on Deceleration time of early diastolic filling (EDT) less than 150 ms during passive leg lifting (OR 2.82, p=<0.05). Concomitant diabetes and chronic kidney disease in hypertensive patients independently predicted left ventricular diastolic dysfunction during passive leg lifting (DM OR 2.82, P<0.05).