Association of glucose metabolism with diastolic function along the diabetic continuum

• Published in: Diabetologia Vol. 53; no. 7; pp. 1331 - 1340
• Main Authors: Stahrenberg, R, Edelmann, F, Mende, M, Kockskämper, A, Düngen, H. D, Scherer, M, Kochen, M. M, Binder, L, Herrmann-Lingen, C, Gelbrich, G, Hasenfuß, G, Pieske, B, Wachter, R
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01.07.2010; Springer-Verlag; Springer; Springer Nature B.V
• Subjects: Aged; Atherosclerosis; Biological and medical sciences; Blood Pressure - physiology; Cardiology; Cardiology. Vascular system; Cross-Sectional Studies; Diabetes; diabetes mellitus; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Diastole - physiology; Diastolic heart failure; Disease; Doppler effect; Echocardiography; Ejection fraction; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Exercise tolerance; Exercise Tolerance - physiology; Female; Flow velocity; Glucose; Glucose - metabolism; Glucose Tolerance Test; Heart; Heart failure; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Failure, Diastolic - metabolism; Human Physiology; Humans; Insulin resistance; Insulin Resistance - physiology; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolism; Middle Aged; Multivariate analysis; Plasma; Prediabetic state; Prediabetic State - metabolism; Prediabetic State - physiopathology; Germany; Diastolic heart failure; Echocardiography; Diabetes mellitus; Insulin resistance; Exercise tolerance; Cross-sectional studies; Prediabetic state; Endocrinopathy; Physical exercise; Heart failure; Tolerance; Metabolic diseases; Cardiovascular disease; Glucose; Metabolism; Target tissue resistance; Association; Heart disease; Cross sectional study
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-010-1718-8

Aims/hypothesis Hyperglycaemia and insulin resistance have been linked to diastolic dysfunction experimentally. We investigated the association between glucose metabolism and diastolic function along the whole spectrum of glucose metabolism states. Methods In the observational Diagnostic Trial on Prevalence and Clinical Course of Diastolic Dysfunction and Diastolic Heart Failure (DIAST-CHF) study, patients with risk factors for heart failure were included. We analysed data including comprehensive echocardiography from a subgroup of patients classified by OGTT and history as normal (n = 343), prediabetic (n = 229) and non-insulin treated (n = 335) or insulin-treated (n = 178) type 2 diabetic. Results While ejection fraction did not differ, markers of diastolic function significantly worsened across groups. Prediabetes represented an intermediate between normal glucose metabolism and diabetes with regard to echocardiography changes. Prevalence and severity of diastolic dysfunction increased significantly (p < 0.001) along the diabetic continuum. Glucose metabolism status was significantly associated with prevalence of diastolic dysfunction on multivariate logistic regression analysis. In the whole cohort, HbA₁c correlated with early diastolic mitral inflow velocity (E):early diastolic tissue Doppler velocity at mitral annulus (e′) ratio (E:e′) (r = 0.20, p < 0.001). HbA₁c was significantly associated with E:e′ on multivariate analysis. Similarly, glucose metabolism status was significantly associated with E:e′ on multivariate analysis. The distance walked in 6 min decreased along the diabetic spectrum and was significantly correlated with E:e′ and grade of diastolic dysfunction. Conclusions/interpretation Glucose metabolism is associated with diastolic dysfunction across the whole spectrum. Our data extend previous observations into the prediabetic and normal range, and may be relevant to preventive approaches, as no effective treatment has been identified for diastolic heart failure once established.