Abstract
The purpose of the present study was to analyze the relationships between echocardiographic findings, brachial-ankle pulse wave velocity, and carotid atherosclerosis in type 2 diabetic patients. In 70 type 2 diabetic patients without cardiovascular disease, pulse wave velocity was measured using an automatic waveform analyzer, and the carotid plaque score was obtained by carotid ultrasonography. The left ventricular wall thickness and the indexes of left ventricular diastolic function (the peak velocity of early rapid filling [E velocity], the peak velocity of atrial filling [A velocity], and the E/A ratio) were obtained by echocardiography. Brachial-ankle pulse wave velocity correlated significantly with the carotid plaque score, but the correlation was weak (r=0.37, p=0.001). The brachial-ankle pulse wave velocity demonstrated a strong correlation with the A velocity (r=0.73, p<0.001), the ratio of E to A (E/A) (r=−0.63, p<0.001), and the deceleration time of the E velocity (r=0.48, p<0.001). Stepwise regression analysis showed that the A velocity (β coefficient=0.42, p<0.001) and ventricular septal thickness at the left ventricular outflow tract (β coefficient=0.27, p=0.001) were independently associated with brachial-ankle pulse wave velocity. Stepwise regression analysis indicated that ventricular septal thickness at the left ventricular outflow tract (β coefficient=0.38, p=0.001) was independently associated with the plaque score. These results indicate that left ventricular diastolic dysfunction as revealed by increased peak velocity of atrial filling reflects arterial stiffening in type 2 diabetic patients. In addition, myocardial wall thickening at the left ventricular outflow tract reflects not only arterial stiffening but also carotid atherosclerosis. Therefore, these abnormal echocardiographic findings of left ventricular diastolic dysfunction and myocardial wall thickening may be useful markers of the presence of progressive arteriosclerosis in type 2 diabetic patients.
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Bell DS : Diabetic cardiomyopathy. Diabetes Care 2003; 26: 2949–2951.
Karvounis HI, Papadopoulos CE, Zaglavara TA, et al: Evidence of left ventricular dysfunction in asymptomatic elderly patients with non-insulin-dependent diabetes mellitus. Angiology 2004; 55: 549–555.
Scognamiglio R, Avogaro A, Negut C, et al: Early myocardial dysfunction in the diabetic heart: current research and clinical applications. Am J Cardiol 2004; 93 ( 8A): 17A–20A.
Brucks S, Little WC, Chao T, et al: Contribution of left ventricular diastolic dysfunction to heart failure regardless of ejection fraction. Am J Cardiol 2005; 95: 603–606.
Zile MR, Brutsaert DL : New concepts in diastolic dysfunction and diastolic heart failure: Part II: causal mechanisms and treatment. Circulation 2002; 105: 1503–1508.
Yamashina A, Tomiyama H, Arai T, et al: Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk. Hypertens Res 2003; 26: 615–622.
Nakashima T, Yamano S, Sasaki R, et al: White-coat hypertension contributes to the presence of carotid arteriosclerosis. Hypertens Res 2004; 27: 739–745.
Munakata M, Sakuraba J, Tayama J, et al: Higher brachial-ankle pulse wave velocity is associated with more advanced carotid atherosclerosis in end-stage renal disease. Hypertens Res 2005; 28: 9–14.
Nakanishi N, Shiraishi T, Wada M : Brachial-ankle pulse wave velocity and metabolic syndrome in a Japanese population: the Minoh study. Hypertens Res 2005; 28: 125–131.
Taniwaki H, Kawagishi T, Emoto M, et al: Correlation between the intima-media thickness of the carotid artery and aortic pulse-wave velocity in patients with type 2 diabetes. Vessel wall properties in type 2 diabetes. Diabetes Care 1999; 22: 1851–1857.
van Popele NM, Grobbee DE, Bots ML, et al: Association between arterial stiffness and atherosclerosis: the Rotterdam Study. Stroke 2001; 32: 454–460.
O'Rourke M : Mechanical principles in arterial disease. Hypertension 1995; 26: 2–9.
Yambe M, Tomiyama H, Hirayama Y, et al: Arterial stiffening as a possible risk factor for both atherosclerosis and diastolic heart failure. Hypertens Res 2004; 27: 625–631.
Nakao M, Nomura K, Karita K, Nishikitani M, Yano E : Relationship between brachial-ankle pulse wave velocity and heart rate variability in young Japanese men. Hypertens Res 2004; 27: 925–931.
Handa N, Matsumoto M, Maeda H, et al: Ultrasonic evaluation of early carotid atherosclerosis. Stroke 1990; 21: 1567–1572.
Devereux RB, Alonso DR, Lutas EM, et al: Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458.
Appleton CP, Firstenberg MS, Garcia MJ, Thomas JD : The echo-Doppler evaluation of left ventricular diastolic function. A current perspective. Cardiol Clin 2000; 18: 513–546.
Poerner TC, Goebel B, Unglaub P, et al: Detection of a pseudonormal mitral inflow pattern: an echocardiographic and tissue Doppler study. Echocardiography 2003; 20: 345–356.
UK Prospective Diabetes Study Group : Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703–713.
Tatchum-Talom R, Niederhoffer N, Amin F, Makki T, Tankosic P, Atkinson J : Aortic stiffness and left ventricular mass in a rat model of isolated systolic hypertension. Hypertension 1995; 26: 963–970.
Nitta K, Akiba T, Uchida K, et al: Left ventricular hypertrophy is associated with arterial stiffness and vascular calcification in hemodialysis patients. Hypertens Res 2004; 27: 47–52.
Bernstein RF, Tei C, Child JS, Shah PM : Angled interventricular septum on echocardiography: anatomic anomaly or technical artifact? J Am Coll Cardiol 1983; 2: 297–304.
Fowles RE, Martin RP, Popp RL : Apparent asymmetric septal hypertrophy due to angled interventricular septum. Am J Cardiol 1980; 46: 386–392.
Tenenbaum A, Fisman EZ, Schwammenthal E, et al: Increased prevalence of left ventricular hypertrophy in hypertensive women with type 2 diabetes mellitus. Cardiovasc Diabetol 2003; 2: 14.
Schirmer H, Lunde P, Rasmussen K : Mitral flow derived Doppler indices of left ventricular diastolic function in a general population; the Tromso study. Eur Heart J 2000; 21: 1376–1386.
Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Bailey KR, Seward JB : Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc 1994; 69: 212–224.
Yamashina A, Tomiyama H, Arai T, et al: Nomogram of the relation of brachial-ankle pulse wave velocity with blood pressure. Hypertens Res 2003; 26: 801–806.
Tomiyama H, Yamashina A, Arai T, et al: Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement—a survey of 12517 subjects. Atherosclerosis 2003; 166: 303–309.
Salmasi AM, Alimo A, Jepson E, Dancy M : Age-associated changes in left ventricular diastolic function are related to increasing left ventricular mass. Am J Hypertens 2003; 16: 473–477.
Mizushige K, Yao L, Noma T, et al: Alteration in left ventricular diastolic filling and accumulation of myocardial collagen at insulin-resistant prediabetic stage of a type II diabetic rat model. Circulation 2000; 101: 899–907.
Noma T, Mizushige K, Yao L, et al: Alteration in aortic wall stiffness and accumulation of collagen during the prediabetic stage of type II diabetes mellitus in rats. Jpn Circ J 1999; 63: 988–993.
Mizushige K, Noma T, Yao L, et al: Effects of troglitazone on collagen accumulation and distensibility of aortic wall in prestage of non-insulin-dependent diabetes mellitus of Otsuka Long-Evans Tokushima Fatty rats. J Cardiovasc Pharmacol 2000; 35: 150–155.
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Masugata, H., Senda, S., Yoshikawa, K. et al. Relationships between Echocardiographic Findings, Pulse Wave Velocity, and Carotid Atherosclerosis in Type 2 Diabetic Patients. Hypertens Res 28, 965–971 (2005). https://doi.org/10.1291/hypres.28.965
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DOI: https://doi.org/10.1291/hypres.28.965
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