Relationship between Aortic Stiffness and the Left Ventricular Function in Patients with Prediabetes

Abstract

Objective Several studies have shown that arterial stiffness and ventricular dysfunction are increased in individuals with type 2 diabetes. Aortic stiffness (AS) reflects the mechanical tension and elasticity of the aorta, and increased aortic stiffness is a risk factor for cardiovascular disease. The aim of this study was to evaluate the degree of aortic stiffness and its relationship with the left ventricular (LV) function in patients with prediabetes and healthy control subjects. Methods The study groups were composed of 50 patients with prediabetes and 47 healthy adults with similar demographic characteristics. The LV systolic and diastolic functions were assessed using standard two dimensional (2D) echocardiography, M-mode echocardiography, pulsed-wave (PW) echocardiography and tissue Doppler echocardiography. The degree of aortic strain and distensibility were calculated based on the aortic diameters measured on M-mode echocardiography at a level 3 cm above the aortic valve and the blood pressure values obtained on sphygmomanometry. Results There were significant differences between the prediabetic and control groups in the degree of aortic strain (4.7±2.8% vs. 14.9±4.5%; respectively, p<0.001) and distensibility (2.0±1.5 vs. 6.8±2.3; 10 -3 cm 2 dyn -1 , respectively, p<0.001). In addition, significant differences were observed between the patient and control groups in the parameters of the LV systolic and diastolic functions. The left atrial diameter was significantly larger in the prediabetics than in the controls (35.9±3.9 vs. 33.7±4.2; respectively, p=0.027). Conclusion AS is increased in patients with prediabetes. In addition, there is a significant relationship between the degree of aortic stiffness and the LV function in this patient population. Therefore, the aortic elasticity parameters calculated on 2D echocardiography are useful for predicting early cardiovascular risks in prediabetics.

Impaired Aortic Elasticity and Diastolic Functions Are Associated with Findings of Coronary Computed Tomographic Angiography

“…Myocardial hypertrophy, ischemia, and age are the most common causes of DD. Diastolic functions are impaired among patients with hypertension, diabetes, and coronary artery disease [20]. We found that patients with DD had more impaired aortic elasticity, higher CACS, more total plaque area, and higher EFV.…”

The role of type 2 diabetes mellitus on hypertensive‐related aortic stiffness

“…41,42 In this way, we detected a high-risk population who can benefit by a simple and close echocardiographic follow-up, to catch the signs of systolic and diastolic myocardial dysfunction at the beginning. 30,41 The study has some limitations. First, even if aortic tissue strain is a new application of TDI which has proved to be useful in studying the aortic elastic properties of patients with hypertension, diastolic dysfunction with elevated filling pressures, 43 type 1 diabetes mellitus, 44 coronarosclerosis, 45 subclinical hypothyroidism, 46 and previously preeclamptic women, 21 this methodology is not yet widespread and accepted.…”

“…In particular, in our study for the first time, we demonstrate the additive role of T2DM on hypertension in causing an arterial stiffness . In this way, we detected a high‐risk population who can benefit by a simple and close echocardiographic follow‐up, to catch the signs of systolic and diastolic myocardial dysfunction at the beginning …”

“…27 On the other hand, the role of diabetes mellitus on aortic stiffness has been demonstrated also in patients without other cardiovascular risk factors as the results of the study on adolescent with type 1 diabetes mellitus 29 and also in patients with prediabetes. 30 The mechanisms by which T2DM contribute to arterial stiffness are principally two. Firstly, the modification of arterial wall structure caused by AGEs, which are able to activate an inflammatory response with consequent endothelial damage.…”

Aortic Stiffness Index and Aortic Distensibility Measured by Echocardiography May Help to Improve the Equivocal Results of Myocardial Perfusion Scintigraphy

“…So, it reflects the cardiovascular burden of the relevant subject. In the studies dealing with arterial stiffness, pulse wave velocity (PWV) technique has been used extensively, but echocardiography has not been used effectively to measure arterial stiffness (10)(11)(12) . It is a very valuable tool in this aspect since it measures central arterial rather than peripheral arterial stiffness, which has better correlation with cardiovascular outcome (13) .…”