Impaired Left Ventricular Diastolic Function and Vascular Postischemic Vasodilation Associated with Microalbuminuria in IDDM Patients

Maria D Guglielmi; Sante D Pierdomenico; Luigi Salvatore; Ferdinando Romano; Evandro Tascione; Mario Pupillo; Ettore Porreca; Tiziana Imbastaro; Franco Cuccurullo; Andrea Mezzetti

doi:10.2337/diacare.18.3.353

Original Articles

Impaired Left Ventricular Diastolic Function and Vascular Postischemic Vasodilation Associated with Microalbuminuria in IDDM Patients

Maria D Guglielmi, MD,
Sante D Pierdomenico, MD,
Luigi Salvatore, MD,
Ferdinando Romano, MD,
Evandro Tascione, MD,
Mario Pupillo, MD,
Ettore Porreca, MD,
Tiziana Imbastaro, BSC,
Franco Cuccurullo, MD and
Andrea Mezzetti, MD

Centro per lo Studio e la Terapia dell'Ipertensione Arteriosa, Istituto di Fisiopatologia Medica, and the Cattedra di Igiene, Università “G. D'Annunzio,” Chieti O.C. Renzetti, Lanciano
Divisione di Medicina O.C. Renzetti, Lanciano
Laboratorio di Patologia Clinica Chieti, Italy

Address correspondence and reprint requests to Andrea Mezzetti, MD, Istituto di Fisiopatologia Medica, c/o Osp. SS. Annunziata, via P.A. Valignani, 66100-Chieti, Italy

Diabetes Care 1995 Mar; 18(3): 353-360. https://doi.org/10.2337/diacare.18.3.353

Abstract

OBJECTIVE Microalbuminuria is considered an important predictor of cardiovascular events in diabetic patients. In this study, a possible association of microalbuminuria with significant changes in left ventricular (LV) morphology and function and generalized vascular dysfunction was analyzed in insulin-dependent diabetes mellitus (IDDM) patients without hypertension, coronary artery disease, or autonomie dysfunction.

RESEARCH DESIGN AND METHODS Thirty-four young long-term IDDM patients, 16 with and 18 without microalbuminuria, and 20 control subjects were studied. LV systolic function and wall thickness were evaluated by M-mode echocardiography. LV diastolic function was studied using a combined echo-Doppler and phonocardiographic technique. The hyperemic response to forearm ischemia was measured by strain-gauge plethysmography. All patients underwent 24-h ambulatory blood pressure monitoring.

RESULTS LV mass index and wall thickness:radius ratio were significantly higher in microalbuminuric patients. LV relaxation was significantly impaired in both diabetic groups compared with control subjects; moreover, this impairment was significantly greater in microalbuminuric than in normoalbuminuric patients. In microalbuminuric patients, forearm postischemic vasodilation was also significantly lower and mean awake diastolic blood pressure (dBP) was significantly higher than in the other two groups.

CONCLUSIONS Our data suggest that microalbuminuria is associated with significant changes in LV morphology, a more severe impairment of cardiac diastolic function, altered vascular dilatory capacity, and higher daytime dBP. Therefore, microalbuminuric patients should be considered to have a higher risk of cardiovascular complications and be kept under closer surveillance.