Arterial Stiffness and Diastolic Dysfunction Explored in Re - PowerPoint Presentation

Slide1

Arterial Stiffness and Diastolic Dysfunction Explored in Relation to Diabetes

From ESH 2016 | LB 3:

Davide

Agnoletti

,

MD

Sacro

Cuore

Hospital, Verona, Italy

Slide2

Study Population

Relation between diastolic function and arterial hemodynamics in diabetic and

nondiabetic

hypertension investigated

123 patients screened for primary or secondary cardiovascular (CV) prevention at Paris hospital; ≥1 CV risk factor

Hemodynamics measured centrally by tonometry and peripherally, diastolic function by echocardiography

Patients with diabetes older, more were smokers and metabolic syndrome, but better lipid control

Diabetic hypertension more commonly treated with angiotensin-receptor blockers, less likely with calcium channel blockersSlide3

Baseline Characteristics

DIAB

, diabetes; eGFR, estimated glomerular filtration rate.

Variables

NO DIAB (n=79)

DIAB (n=44)

Mean (SD)

Mean (SD)

P value

Age, years

56(14)

64(9)

0.0028

Male gender, n (%)

39(49)

28(64)

0.1277

Weight, kg

78(15)

80(14)

0.457

Height, cm

168(9)

168(8)

0.8058

Body mass index, kg/m

2

28(5)

28(4)

0.5132

Waist circumference, mm

94(13)

100(11)

0.0073

Total cholesterol, mmol/L

4.79(1.02)

4.08(1.02)

0.0004

HDL cholesterol, mmol/L

1.38(0.41)

1.22(0.42)

0.0513

Triglycerides, mmol/L

1.20(0.77)

1.41(0.79)

0.1647

LDL cholesterol, mmol/L

2.88(0.84)

2.24(0.83)

0.0001

Creatinine, µmol/L

84(21)

90(25)

0.1185

eGFR, mL/min

81(20)

76(20)

0.2229Slide4

Baseline Characteristics

DIAB

, diabetes

; CHD, coronary heart

disease

.

Variables

NO DIAB (n=79)

DIAB (n=44)

N (%)

N (%)

P value

Smoking

35(44)

28(64)

0.0398

Hypertension

71(90)

38(86)

0.5569

Familiarity for CHD

5(6)

5(11)

0.3274

Stroke

4(5)

3(7)

0.6872

CHD

6(8)

6(14)

0.2411

Myocardial infarction

3(4)

4(9)

0.2245

Revascularization

5(6)

6(14)

0.1734

Peripheral artery disease

2(3)

5(11)

0.0969

Metabolic Syndrome

17(22)

28(64)

<.0001Slide5

Results

Similar central and peripheral blood pressure levels in patients with hypertension with and without diabetes

Carotid-femoral pulse wave velocity significantly higher in diabetic hypertension

Augmentation index and pulse pressure amplification similar regardless of diabetes status

Diastolic and systolic function similar regardless of diabetes statusSlide6

Hemodynamic Outcomes By Diabetic Status

AIx

, augmentation index;

cf

-PWV, carotid-femoral pulse wave velocity; DIAB, diabetes; PPA, pulse pressure amplification.

Hemodynamics

:

*p<0.05Slide7

Results

Pulse wave velocity and E/E’ ratio positively and significantly related in total population (r=0.199; p=0.027)

No difference by diabetes status after adjustment for age, sex, mean arterial pressure, heart rate

Pulse pressure amplification and the E/E’ ratio negatively and significantly related in total population (r=0.172; p=0.057) and in diabetic hypertension (r=0.352; p=0.019)

Determinant of pulse pressure amplification differ by diabetic status

Diabetes: use of blockers of renin angiotensin system, E/E’ ratio

No diabetes: family history of coronary heart disease, mean arterial pressureSlide8

Conclusion

Positive relation between arterial stiffness and diastolic dysfunction found in total study population of patients with hypertension with and without diabetes

In diabetic hypertension, pulse pressure amplification inversely related to diastolic dysfunction

14% of the variance in pulse pressure amplification due to E/E’ ratioSlide9

Arterial Stiffness and Diastolic Dysfunction Explored in Relation to Diabetes

From ESH 2016 | LB 3:

Davide

Agnoletti

,

MD

Sacro

Cuore

Hospital, Verona, Italy