Combined influence of diabetes mellitus and obesity on left ventricle remodeling in hypertensive patients
DOI:
https://doi.org/10.14739/2310-1210.2021.1.224880Keywords:
essential hypertension, left ventricular remodeling, diabetes mellitus, obesity, myocardial hypertrophyAbstract
The aim of the study was to evaluate the effect of type 2 diabetes mellitus (T2DM) and obesity influence on the left ventricular (LV) remodeling peculiarities in hypertensive patients.
Materials and methods. In total, 327 patients, aged 38–74 years, were comprehensively examined. The enrolled patients were divided into 4 groups in dependence of the presence of associated disease: the 1st group – n = 87 hypertensive patients with T2DM combined with obesity, the 2nd group – n = 71 hypertensive patient with T2DM and the 3rd group – n = 65 hypertensive patients with obesity; the comparison group consisted of 74 patients with essential hypertension (EH) but without obesity or diabetes. Echocardiography was performed according to the standard method of H. Feigenbaum to estimate the LV parameters. HbA1c was determined by turbidimetric method. Serum glucose levels were determined by ELISA.
Results. When comparing the three patient groups with those who had only EH, the most significant influence was found in combined influence of T2DM and obesity on the development of unfavorable type of LV remodeling with values of χ2 = 29.371 and Pearson's contingency coefficient (C) ‒ 0.393 (P < 0.05). The presence of concomitant T2DM without obesity had a significant moderate relationship with the development of unfavorable LV geometry, χ2 = 11.029 and C ‒ 0.266 (P < 0.05), which indicates a much smaller impact on the process compared to the polymorbid effect of T2DM with obesity. Comparison of patients with a combination of EH and obesity with those who had only EH did not show a significant effect of concomitant obesity on the development of unfavorable types of LV geometry with values of χ2 and C: 0.529 and 0.062, respectively (P > 0.05).
Conclusions. Essential hypertension with type 2 diabetes mellitus and obesity polymorbidity, but not in combination with type 2 diabetes mellitus or obesity alone, has the most significant association with hypertrophic types of LV remodeling. The co-existence of type 2 diabetes mellitus and obesity in hypertensive patients leads to the development of predominantly LV concentric hypertrophy.
References
Lancellotti, P., Galderisi, M., Edvardsen, T., Donal, E., Goliasch, G., Cardim, N., Magne, J., Laginha, S., Hagendorff, A., Haland, T. F., Aaberge, L., Martinez, C., Rapacciuolo, A., Santoro, C., Ilardi, F., Postolache, A., Dulgheru, R., Mateescu, A. D., Beladan, C. C., Deleanu, D., … Popescu, B. A. (2017). Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI Euro-Filling study. European Heart Journal - Cardiovascular Imaging, 18(9), 961-968. https://doi.org/10.1093/ehjci/jex067
Andersen, O. S., Smiseth, O. A., Dokainish, H., Abudiab, M. M., Schutt, R. C., Kumar, A., Sato, K., Harb, S., Gude, E., Remme, E. W., Andreassen, A. K., Ha, J. W., Xu, J., Klein, A. L., & Nagueh, S. F. (2017). Estimating Left Ventricular Filling Pressure by Echocardiography. Journal of the American College of Cardiology, 69(15), 1937-1948. https://doi.org/10.1016/j.jacc.2017.01.058
Sanchis, L., Andrea, R., Falces, C., Poyatos, S., Vidal, B., & Sitges, M. (2018). Differential Clinical Implications of Current Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography. Journal of the American Society of Echocardiography, 31(11), 1203-1208. https://doi.org/10.1016/j.echo.2018.08.011
Cokkinos, D. V., & Belogianneas, C. (2016). Left Ventricular Remodelling: A Problem in Search of Solutions. European Cardiology Review, 11(1), 29-35. https://doi.org/10.15420/ecr.2015:9:3
Krukov, E. V., Orlov, F. A., & Alatortseva, I. A. (2019). Klinicheskaya otsenka faktorov riska serdechno-sosudistykh oslozhnenii metodom matematicheskogo modelirovaniya u patsientov s raznymi geometricheskimi modelyami serdtsa [Clinical assessment of cardiovascular complication risk factors by a mathematic modeling method in patients with different geometric heart models]. Sovremennye problemy zdravookhraneniya i meditsinskoi statistiki, (3), 1-15. https://doi.org/10.24411/2312-2935-2019-10051 [in Russian].
Yildiz, M., Oktay, A. A., Stewart, M. H., Milani, R. V., Ventura, H. O., & Lavie, C. J. (2020). Left ventricular hypertrophy and hypertension. Progress in Cardiovascular Diseases, 63(1), 10-21. https://doi.org/10.1016/j.pcad.2019.11.009
Verdecchia, P., Angeli, F., Mazzotta, G., Bartolini, C., Garofoli, M., Aita, A., Poltronieri, C., Pinzagli, M. G., Valecchi, F., Martone, S., Ramundo, E., Turturiello, D., & Reboldi, G. (2017). Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension. Journal of the American Heart Association, 6(6), Article e005948. https://doi.org/10.1161/JAHA.117.005948
Paoletti, E., De Nicola, L., Gabbai, F. B., Chiodini, P., Ravera, M., Pieracci, L., Marre, S., Cassottana, P., Lucà, S., Vettoretti, S., Borrelli, S., Conte, G., & Minutolo, R. (2016). Associations of Left Ventricular Hypertrophy and Geometry with Adverse Outcomes in Patients with CKD and Hypertension. Clinical journal of the American Society of Nephrology, 11(2), 271-279. https://doi.org/10.2215/CJN.06980615
Cromwell, C. M., Aichele, K. R., Oakman, J. E., Neal, M. P., Lenzo, J. M., Perez, A. N., Bye, N. L., Santaniello, E. L., Hill, J. A., Evans, R. C., Thiele, K. A., Chavis, L. N., Getty, A. K., Wisdo, T. R., & Feairheller, D. L. (2016). Carotid Artery IMT, Blood Pressure, and Cardiovascular Risk Factors in Males and Females. International Journal of Exercise Science, 9(4), 482-490.
Polozova, E. I., & Mamkina, N. N. (2017). Osobennosti strukturno-geometricheskoi perestroiki levogo zheludochka u bol'nykh s metabolicheskim sindromom i arterial'noi gipertenziei [Remodeling in left ventriculat structure and geometry in patients with metabolic syndrome and arterial hypertension]. Ul'yanovskii mediko-biologicheskii zhurnal, (4), 26-32. https://doi.org/10.23648/UMBJ.2017.28.8737 [in Russian].
Shakhnovich, P. G., Zakharova, A. I., Cherkashin, D. V., Svistov, A. S., Shalenin, K. S., Tkachenko, K. N., Alanichev, A. E., Makiev, R. G., Kutelev, G. G., & Efimov, S. V. (2015). Diastolicheskaya disfunktsiya miokarda: ekhokardiograficheskii fenomen ili vid serdechnoi nedostatochnosti? [Diastolic myocardium dysfunction: echocardiographic phenomenon or type of heart failure?]. Vestnik rossiiskoi voenno-meditsinskoi akademii, (3), 54-57. [in Russian].
Tsao, C. W., Gona, P. N., Salton, C. J., Chuang, M. L., Levy, D., Manning, W. J., & O'Donnell, C. J. (2015). Left Ventricular Structure and Risk of Cardiovascular Events: A Framingham Heart Study Cardiac Magnetic Resonance Study. Journal of the American Heart Association, 4(9), Article e002188. https://doi.org/10.1161/JAHA.115.002188
Aljaroudi, W., Alraies, M. C., Halley, C., Rodriguez, L., Grimm, R. A., Thomas, J. D., & Jaber, W. A. (2012). Impact of progression of diastolic dysfunction on mortality in patients with normal ejection fraction. Circulation, 125(6), 782-788. https://doi.org/10.1161/CIRCULATIONAHA.111.066423
Soliman, E. Z., Ambrosius, W. T., Cushman, W. C., Zhang, Z. M., Bates, J. T., Neyra, J. A., Carson, T. Y., Tamariz, L., Ghazi, L., Cho, M. E., Shapiro, B. P., He, J., Fine, L. J., Lewis, C. E., & SPRINT Research Study Group. (2017). Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial). Circulation, 136(5), 440-450. https://doi.org/10.1161/CIRCULATIONAHA.117.028441
Katsiki, N., Tsioufis, K., Ural, D., & Volpe, M. (2018). Fifteen years of LIFE (Losartan Intervention for Endpoint Reduction in Hypertension)-Lessons learned for losartan: An "old dog playing good tricks". Journal of Clinical Hypertension, 20(8), 1153-1159. https://doi.org/10.1111/jch.13325
Anstey, D. E., Tanner, R. M., Booth, J. N., 3rd, Bress, A. P., Diaz, K. M., Sims, M., Ogedegbe, G., Muntner, P., & Abdalla, M. (2019). Inappropriate Left Ventricular Mass and Cardiovascular Disease Events and Mortality in Blacks: The Jackson Heart Study. Journal of the American Heart Association, 8(16), Article e011897. https://doi.org/10.1161/JAHA.118.011897
Cuspidi, C., Sala, C., Casati, A., Bombelli, M., Grassi, G., & Mancia, G. (2017). Clinical and prognostic value of hypertensive cardiac damage in the PAMELA Study. Hypertension Research, 40(4), 329-335. https://doi.org/10.1038/hr.2016.153
Li, T., Chen, S., Guo, X., Yang, J., & Sun, Y. (2017). Impact of hypertension with or without diabetes on left ventricular remodeling in rural Chinese population: a cross-sectional study. BMC Cardiovascular Disorders, 17(1), Article 206. https://doi.org/10.1186/s12872-017-0642-y
De Jong, K. A., Czeczor, J. K., Sithara, S., McEwen, K., Lopaschuk, G. D., Appelbe, A., Cukier, K., Kotowicz, M., & McGee, S. L. (2017). Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study. Cardiovascular Diabetology, 16(1), Article 21. https://doi.org/10.1186/s12933-017-0504-z
Azevedo, P. S., Polegato, B. F., Minicucci, M. F., Paiva, S. A., & Zornoff, L. A. (2016). Cardiac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment. Arquivos Brasileiros de Cardiologia, 106(1), 62-69. https://doi.org/10.5935/abc.20160005
Roush, G. C., Abdelfattah, R., Song, S., Kostis, J. B., Ernst, M. E., & Sica, D. A. (2018). Hydrochlorothiazide and alternative diuretics versus renin-angiotensin system inhibitors for the regression of left ventricular hypertrophy: a head-to-head meta-analysis. Journal of Hypertension, 36(6), 1247-1255. https://doi.org/10.1097/HJH.0000000000001691
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