title: The impact of diabetes on left ventricular filling pattern in normotensive and hypertensive adults: the Strong Heart Study.
abstract: OBJECTIVE
  We sought to determine the effect of diabetes mellitus (DM) on left ventricular (LV) filling pattern in normotensive (NT) and hypertensive (HTN) individuals.
  
  
  BACKGROUND
  Diastolic abnormalities have been extensively described in HTN but are less well characterized in DM, which frequently coexists with HTN.
  
  
  METHODS
  We analyzed the transmitral inflow velocity profile at the mitral annulus in four groups from the Strong Heart Study: NT-non-DM (n = 730), HTN-non-DM (n = 394), NT-DM (n = 616) and HTN-DM (n = 671). The DM subjects were further divided into those with normal filling pattern (n = 107) and those with abnormal relaxation (AbnREL) (n = 447).
  
  
  RESULTS
  The peak E velocity was lowest in HTN-DM, intermediate in NT-DM and HT-non-DM and highest in the NT-non-DM group (p < 0.001), with a reverse trend seen for peak A velocity (p < 0.001). In multivariate analysis, E/A ratio was lowest in HTN-DM and highest in NT-non-DM, with no difference between NT-DM and HTN-non DM (p < 0.001). Likewise, mean atrial filling fraction and deceleration time were highest in HTN-DM, followed by HTN-non-DM or NT-DM and lowest in NT-non-DM (both p < 0.05). Among DM subjects, those with AbnREL had higher fasting glucose (p = 0.03) and hemoglobin A1C (p = 0.04).
  
  
  CONCLUSIONS
  Diabetes mellitus, especially with worse glycemic control, is independently associated with abnormal LV relaxation. The severity of abnormal LV relaxation is similar to the well-known impaired relaxation associated with HTN. The combination of DM and HTN has more severe abnormal LV relaxation than groups with either condition alone. In addition, AbnREL in DM is associated with worse glycemic control.
authors.affiliation: Department of Medicine, The New York Hospital-Cornell Medical Center, New York 10021, USA. jeliu@med.cornell.edu
authors.forename: J E
authors.initials: JE
authors.lastname: Liu
authors.forename: V
authors.initials: V
authors.lastname: Palmieri
authors.forename: M J
authors.initials: MJ
authors.lastname: Roman
authors.forename: J N
authors.initials: JN
authors.lastname: Bella
authors.forename: R
authors.initials: R
authors.lastname: Fabsitz
authors.forename: B V
authors.initials: BV
authors.lastname: Howard
authors.forename: T K
authors.initials: TK
authors.lastname: Welty
authors.forename: E T
authors.initials: ET
authors.lastname: Lee
authors.forename: R B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D001783:Blood Flow Velocity; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D016277:Ventricular Function, Left