title: Impaired fasting glucose and left ventricular diastolic dysfunction in middle-age adults: a retrospective cross-sectional analysis of 2971 subjects.
abstract: BACKGROUND
  Left ventricular (LV) diastolic dysfunction (LVDD) is a well-established and early echocardiographic characteristic of diabetic cardiomyopathy. However, there are limited data on the association between impaired fasting glucose (IFG) and LVDD.
  
  
  OBJECTIVE
  To determine whether IFG is associated with LVDD among middle age adults.
  
  
  METHODS
  Amongst 3781 subjects screened in an annual health survey program and referred for an echocardiogram, 2971 individuals without LV systolic dysfunction or valvular heart disease were selected. Mean age of study population was 59 ± 12 years and 75% were men. The subjects were categorized into three groups: euglycemia (N = 2025), IFG (N = 534) and diabetes mellitus (DM; N = 412). Doppler echocardiography readers were blinded to glycemic state. Subjects with impaired LV relaxation, pseudo-normal or restrictive filling patterns were defined as having LVDD.
  
  
  RESULTS
  LVDD was diagnosed in 574 (19 %) of subjects and it was more prevalent among patients with IFG and DM than in euglycemic individuals (27, 30 and 15%, respectively; p < 0.001). Patients with IFG and DM had lower ratios of early (E) to late (A) trans-mitral flow (0.9 ± 0.3 and 0.9 ± 0.3 vs. 1.1 ± 0.4, respectively, p < 0.001). LV hypertrophy (LVH) was also more prevalent among patients with IFG and DM (11 and 18%, respectively, vs. 9%; p < 0.001). Multivariate binary logistic regression model adjusted to age, gender, obesity, LVH, renal function, total, high and low density lipoprotein cholesterol, triglycerides, ischemic heart disease, hypertension and LV ejection fraction showed that patients with IFG were 43% more likely to have LVDD compared with euglycemic subjects (95% confidence interval 1.12-1.83, p = 0.004).
  
  
  CONCLUSIONS
  IFG is independently associated with a significant increase in the likelihood for the presence of LVDD in middle aged adults.
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. assi_mil@hotmail.com.|Department of Internal Medicine "E", Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel. assi_mil@hotmail.com.
authors.forename: Assi
authors.initials: A
authors.lastname: Milwidsky
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. eladmaor@gmail.com.|Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Ramat Gan, Israel. eladmaor@gmail.com.
authors.forename: Elad
authors.initials: E
authors.lastname: Maor
authors.affiliation: Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel. kivitys@gmail.com.|Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Ramat Gan, Israel. kivitys@gmail.com.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. kivitys@gmail.com.
authors.forename: Shaye
authors.initials: S
authors.lastname: Kivity
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. anat.berko@gmail.com.
authors.forename: Anat
authors.initials: A
authors.lastname: Berkovitch
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. ssaaggiitt@yahoo.com.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. ssaaggiitt@yahoo.com.
authors.forename: Sagit Ben
authors.initials: SB
authors.lastname: Zekry
authors.affiliation: Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Ramat Gan, Israel. alexander.tenenbasum@sheba.health.gov.il.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. alexander.tenenbasum@sheba.health.gov.il.|Cardiovascular Diabetology Research Foundation, Holon, Israel. alexander.tenenbasum@sheba.health.gov.il.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tenenbaum
authors.affiliation: Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. zfisman@post.tau.ac.il.|Cardiovascular Diabetology Research Foundation, Holon, Israel. zfisman@post.tau.ac.il.
authors.forename: Enrique Z
authors.initials: EZ
authors.lastname: Fisman
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. aharon.erez@gmail.com.
authors.forename: Aharon
authors.initials: A
authors.lastname: Erez
authors.affiliation: Institute for Medical Screening, Chaim Sheba Medical Center, Ramat Gan, Israel. shlomo.segev@sheba.health.gov.il.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Segev
authors.affiliation: Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel. ysidi48@gmail.com.|Department of Internal Medicine "E", Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel. ysidi48@gmail.com.
authors.forename: Yechezkel
authors.initials: Y
authors.lastname: Sidi
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. ilan.goldenberg@sheba.health.gov.il.|Department of Internal Medicine "E", Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel. ilan.goldenberg@sheba.health.gov.il.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. rafikupe@gmail.com.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. rafikupe@gmail.com.
authors.forename: Rafael
authors.initials: R
authors.lastname: Kuperstein
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D003971:Diastole; D015150:Echocardiography, Doppler; D005215:Fasting / Q000097:blood*; D005260:Female; D044882:Glucose Metabolism Disorders / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D001786:Blood Glucose