Left ventricular chamber dilation and filling pressure may help to categorise patients with type 2 diabetes

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

Early impairment in left ventricular longitudinal systolic function is associated with an increased risk of incident atrial fibrillation in patients with type 2 diabetes

It is known that type 2 diabetic patients are at high risk of atrial fibrillation (AF). However, the early echocardiographic determinants of AF vulnerability in this patient population remain poorly known

Heart valve calcification in patients with type 2 diabetes and nonalcoholic fatty liver disease

PurposeAortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are two powerful predictors of adverse cardiovascular outcomes in patients with type 2 diabetes, but the aetiology of valvular calcification is uncertain. Nonalcoholic fatty liver disease (NAFLD) is an emerging cardiovascular risk factor and is very common in type 2 diabetes, but whether NAFLD is associated with valvular calcification in this group of patients is presently unknown.MethodsWe undertook a cross-sectional study of 247 consecutive type 2 diabetic outpatients with no previous history of heart failure, valvular heart diseases (aortic stenosis, mitral stenosis, moderate or severe aortic and mitral regurgitation) or hepatic diseases. Presence of MAC and AVS was detected by echocardiography. NAFLD was diagnosed by ultrasonography.ResultsOverall, 139 (56.3%) patients had no heart valve calcification (HVC-0), 65 (26.3%) patients had one valve affected (HVC-1) and 43 (17.4%) patients had both valves affected (HVC-2). 175 (70.8%) patients had NAFLD and the prevalence of this disease markedly increased in patients with HVC-2 compared with either HVC-1 or HVC-0 (86.1% vs. 83.1% vs. 60.4%, respectively; p<0.001). NAFLD was significantly associated with AVS and/or MAC (unadjusted-odds ratio 3.51, 95%CI 1.89–6.51, p<0.001). Adjustments for age, sex, waist circumference, smoking, blood pressure, hemoglobin A1c, LDL-cholesterol, kidney function parameters, medication use and echocardiographic variables did not appreciably weaken this association (adjusted-odds ratio 2.70, 95%CI 1.23-7.38, p<0.01).ConclusionsOur results show that NAFLD is an independent predictor of cardiac calcification in both the aortic and mitral valves in patients with type 2 diabetes

Increased Risk of CKD among Type 2 Diabetics with Nonalcoholic Fatty Liver Disease

It is unknown whether chronic kidney disease (CKD) is associated with nonalcoholic fatty liver disease among patients with type 2 diabetes. We followed 1760 outpatients with type 2 diabetes and normal or near-normal kidney function and without overt proteinuria for 6.5 yr for the occurrence of CKD (defined as overt proteinuria and/or estimated GFR <60 ml/min per 1.73 m2). During follow-up, 547 participants developed incident CKD. Nonalcoholic fatty liver disease, diagnosed by liver ultrasound and exclusion of other common causes of chronic liver disease, was associated with a moderately increased risk for CKD (hazard ratio 1.69; 95% confidence interval 1.3 to 2.6; P < 0.001). Adjustments for gender, age, body mass index, waist circumference, BP, smoking, diabetes duration, glycosylated hemoglobin, lipids, baseline estimated GFR, microalbuminuria, and medications (hypoglycemic, lipid-lowering, antihypertensive, or antiplatelet drugs) did not appreciably attenuate this association (hazard ratio 1.49; 95% confidence interval 1.1 to 2.2; P < 0.01). In conclusion, our findings suggest that nonalcoholic fatty liver disease is associated with an increased incidence of CKD in individuals with type 2 diabetes, independent of numerous baseline confounding factors

Association between subclinical left ventricular systolic dysfunction and glycemic control in asymptomatic type 2 diabetic patients with preserved left ventricular function

Type 2 diabetes is strongly associated with the occurrence of cardiovascular diseases, especially heart failure. Some studies have suggested that subclinical systolic dysfunction as assessed by tissue Doppler imaging (TDI) is already present in uncomplicated diabetic patients with normal left ventricular ejection fraction (LVEF). Considering the importance of this aspect, the aim of this cross-sectional study was to examine the relationship between glycated hemoglobin and mean s' wave velocity (a reliable measure of early LV systolic dysfunction) in a cohort of type 2 diabetic outpatients with preserved LVEF and without ischemic heart disease

Relationship between increased left atrial volume and microvascular complications in patients with type 2 diabetes

Aims: We assessed whether left atrial volume index (LAVI) was associated with the presence of microvascular complications in patients with type 2 diabetes, and whether this association was independent of hemodynamic and non-hemodynamic factors.Methods: We studied 157 consecutive outpatients with type 2 diabetes with no previous history of ischemic heart disease, chronic heart failure and valvular diseases. A transthoracic echocardiography and myocardial perfusion scintigraphy were performed in all participants. Presence of microvascular complications was also recorded. Results: Overall, 51 patients had decreased estimated glomerular filtration rate and/or abnormal albuminuria, 24 had diabetic retinopathy, 22 had lower-extremity sensory neuropathy, and 67 (42.7%) patients had one or more of these microvascular complications (i.e., combined endpoint). After stratifying patients by LAVI, those with LAVI 6532 ml/m2 had a greater prevalence of microvascular complication, lower left ventricular (LV) ejection fraction, higher LV mass index and higher E/e\u2019 ratio than those with LAVI b32 ml/m2. Logistic regression analyses revealed that microvascular complications (singly or in combination) were associated with increased LAVI, independently of age, sex, diabetes duration, hemoglobin A1c, hypertension, LV-ejection fraction, LV mass index and the E/e\u2019 ratio. Conclusions: These results indicate that microvascular diabetic complications are associated with increased LAVI in well-controlled type 2 diabetic patients with preserved systolic function and free from ischemic heart disease, independently of multiple potential confounders

Non-alcoholic fatty liver disease is associated with an increased incidence of atrial fibrillation in patients with type 2 diabetes

BACKGROUND: The relationship between non-alcoholic fatty liver disease (NAFLD) and atrial fibrillation (AF) in type 2 diabetes is currently unknown. We examined the relationship between NAFLD and risk of incident AF in people with type 2 diabetes. METHODS AND RESULTS: We prospectively followed for 10 years a random sample of 400 patients with type 2 diabetes, who were free from AF at baseline. A standard 12-lead electrocardiogram was undertaken annually and a diagnosis of incident AF was confirmed in affected participants by a single cardiologist. At baseline, NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other liver diseases. During the 10 years of follow-up, there were 42 (10.5%) incident AF cases. NAFLD was associated with an increased risk of incident AF (odds ratio [OR] 4.49, 95% CI 1.6-12.9, p<0.005). Adjustments for age, sex, hypertension and electrocardiographic features (left ventricular hypertrophy and PR interval) did not attenuate the association between NAFLD and incident AF (adjusted-OR 6.38, 95% CI 1.7-24.2, p = 0.005). Further adjustment for variables that were included in the 10-year Framingham Heart Study-derived AF risk score did not appreciably weaken this association. Other independent predictors of AF were older age, longer PR interval and left ventricular hypertrophy. CONCLUSIONS: Our results indicate that ultrasound-diagnosed NAFLD is strongly associated with an increased incidence of AF in patients with type 2 diabetes even after adjustment for important clinical risk factors for AF

Logistic regression models for NAFLD as a predictor for AVS in patients with type 2 diabetes.

<p>Sample size, <i>n</i> = 180. Data are expressed as odds ratios ±95% confidence intervals (CI) as assessed by univariable (unadjusted) or multivariable logistic regression analyses.</p><p>Other covariates included in multivariable logistic regression models, along with NAFLD, were as follows: <b>model 1</b>: age and sex; <b>model 2:</b> age, sex, BMI, smoking status, daily alcohol consumption, hypertension (i.e. blood pressure ≥140/90 mmHg and/or anti-hypertensive treatment) and dyslipidemia (i.e. LDL-cholesterol >130 mg/dl and/or triglycerides >200 mg/dl and/or HDL-cholesterol <40 mg/dl for women or <35 mg/dl for men and/or lipid-lowering treatment); <b>model 3:</b> adjustment for variables included in model 2 <i>plus</i> duration of diabetes, diabetes treatment, HbA1c, and estimated GFR.</p

Proportion of type 2 diabetic patients with aortic valve sclerosis (AVS) in relation to the ultrasonographic severity of NAFLD.

<p>Data are adjusted for age and sex.</p

Clinical and biochemical characteristics of participants stratified by aortic valve sclerosis on echocardiography.

<p>Sample size, <i>n</i> = 180. Data are means ± SD or proportions. Differences between the two groups were tested by the unpaired Student’s <i>t</i>-test (for continuous variables) and the chi-squared test (for categorical variables).</p><p>ALT, alanine aminotransferase; BMI, body mass index; GFR, glomerular filtration rate; GGT, gamma-glutamyl-transferase; LV, left ventricular; MAC, mitral annulus calcification.</p><p>Hypertension was defined as blood pressure ≥140/90 mmHg and/or anti-hypertensive treatment. Dyslipidemia was defined as LDL-cholesterol >130 mg/dl and/or triglycerides >200 mg/dl and/or HDL-cholesterol <40 mg/dl for women or <35 mg/dl for men and/or lipid-lowering treatment.</p