title: The degree of albuminuria is related to left ventricular hypertrophy in hypertensive diabetics and is associated with abnormal left ventricular filling: a pilot study.
abstract: The association of albuminuria and left ventricular (LV) hypertrophy (LVH) in diabetics aggravates the prognosis. The authors studied the relation between LVH and the degree of albuminuria in diabetics and investigated the relationship of albuminuria to LV filling. A comparison was made between 30 hypertensive diabetics, 10 of whom had microalbuminuria (MIC) and 20 had macroalbuminuria (MAC), and 18 diabetics who were normotensive and normalbuminuric (NOR). LV mass index (LVMI) and LV ejection fraction (LVEF) were measured during echocardiography. LV filling pattern at rest and at peak standardized isometric exercise (IME) using handgrip was assessed by measuring E/A (peak velocity of the early/atrial filling waves) of the transmitral flow during Doppler and echocardiography. Each patient underwent a stress ECG test. LVMI was higher in MAC (132.3 +/- 55.4) than in MIC (115.6 +/- 32.5) or NOR (90.0 +/- 31.8) (p<0.01). There were more patients in MAC with LVH (n = 13) and abnormal filling (n = 9 at rest and 16 with IME) than in MIC (LVH = 5, abnormal filling = 1 at rest and 10 during IME) or NOR (LVH = 3, abnormal filling = 1 at rest and 9 during IME) (p < 0.02). LVMI was not related to LVEF. Although blood pressure was not different between MAC and MIC groups, it was significantly higher than in the NOR group. This study suggests that a high degree of albuminuria in hypertensive diabetics is associated with greater value for LVMI and an increased incidence of LVH independent of blood pressure level or systolic LV function. LVH is associated with abnormal LV filling. The degree of albuminuria may predict LVMI and LVH, which are associated with abnormal LV filling. This association of abnormal LV filling with albuminuria in hypertensive diabetic patients may account for their high risk of cardiovascular events.
authors.affiliation: Cardiology Department, Central Middlesex Hospital, London, UK. majeed.salmasi@nwlh.nhs.uk
authors.forename: Abdul-Majeed
authors.initials: AM
authors.lastname: Salmasi
authors.forename: Ewart
authors.initials: E
authors.lastname: Jepson
authors.forename: Ana
authors.initials: A
authors.lastname: Grenfell
authors.forename: Camelia
authors.initials: C
authors.lastname: Kirollos
authors.forename: Mark
authors.initials: M
authors.lastname: Dancy
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications* / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016277:Ventricular Function, Left