Association of albuminuria with impaired aortic elasticity and left ventricular diastolic dysfunction in type 2 diabetes.
OBJECTIVE
Albuminuria is a predictor of cardiovascular morbidity and mortality in patients with diabetes (DM). In this study, we tested the hypothesis suggesting that the presence of albuminuria reflects impaired aortic elastic properties in type 2 DM.


METHODS
Overall 140 patients with type 2 DM without obvious renal impairment (serum creatinine <1.5 mg/dl) were included in this cross-sectional study. Patients were divided into 3 groups based on amount of albuminuria: Group 1 - patients with no signs of albuminuria (16 men, 34 women, mean age 51+/-11 years); Group 2--patients with microalbuminuria (15 men, 35 women, mean age 52+/-9 years); Group 3--patients with macroalbuminuria (14 men, 26 women, mean age 56+/-8 years). Each patient underwent transthoracic two-dimensional and Doppler echocardiography with assessment of diastolic function, aortic strain and aortic root distensibility. Statistical analysis was performed using ANOVA analysis for comparison of variables between 3 groups. The relationship of albuminuria with clinical variables, parameters of left ventricular mass, diastolic function, aortic strain and distensibility was assessed using multivariate regression analysis.


RESULTS
A significant stepwise decrease in the aortic strain and distensibility was seen across Group 1 to Group 3. Similar findings were noted in left ventricular diastolic functions with longer deceleration time (DT) and lower peak early to late transmitral filling velocity ratios (E/A) in groups with albuminuria. Aortic distensibility significantly correlated with DT (r=-0.35, p<0.001), isovolumic relaxation time (r=-0.31, p<0.005) and left ventricular mass/height2.7 (r =-0.26, p<0.005). In multivariate analysis, the amount of albumin was significantly associated with aortic distensibility (standardized beta coefficient -0.23, p<0.01) and DT (standardized beta coefficient 0.26, p<0.005).


CONCLUSIONS
Our results suggest increased urinary albumin excretion is significantly correlated with impaired aortic elastic properties and left ventricular diastolic dysfunction in type 2 diabetes, which may contribute to the relation of albuminuria and increased rate of cardiovascular events among diabetics.
Duman
Dursun
D
Department of Cardiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey. drduman@excite.com
Demirtunç
Refik
R
Karadağ
Bilgehan
B
Karataş
Meryem
M
D000419:Albuminuria / Q000150:complications / Q000503:physiopathology*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000502:physiology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D014664:Vasodilation / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology*