Russian Heart Failure Journal 2008year Structure and function base of heart failure in type 2 diabetes mellitus and its dependence on the degree of obesity and other components of metabolic syndrome


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2008/

Structure and function base of heart failure in type 2 diabetes mellitus and its dependence on the degree of obesity and other components of metabolic syndrome

Trelskaya N.Yu., Dmitriev A. N., Sarapultsev P. A., Trelsky P. E.

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Urgency. Prevalence of cardiovascular diseases is 4 times higher among patients with type 2 DM than in general population. These diseases cause death of 70-80% of patients, which may be related with negative effects of metabolic disorders characteristic of metabolic syndrome (MS) with obesity as its major component. Aim. To establish the nature and degree of the effect of obesity and other MS components on structure and function changes in the myocardium of patients with DM2. Materials and methods. An echoCG study was performed using a standard method on 86 patients with type 2 DM and concomitant obesity without clinically evident angina or history of myocardial infarction and on 15 patients with type 2 DM with normal body weight (reference group). Control group consisted of 36 individuals without apparent disease and hereditary load of DM. Results. Patients with type 2 DM and degree III or IV obesity had significantly larger LA as compared to the control. Both interventricular septal thickness (IVST) and left ventricular posterior wall thickness (LVPWT) also had maximal differences between the reference group and the degree IV obesity group. Left ventricular myocardial mass was significantly higher than in the reference group, which was associated with eccentric LV hypertrophy in degree I-III obesity and concentric LV hypertrophy in degree IV obesity. Left ventricular isovolumetric relaxation time (IVRT LV), A peak, E peak, and E/A ratio considerably differed from those in the control group and reflected formation of a pseudonormal type of diastolic dysfunction. Values of SV, EF and volume/mass ratio (VMR) were significantly lower in the degree IV obesity group than in the reference group, which indicated a decrease in LV systolic function perhaps aggravated by present arterial hypertension (AH). Therefore the observed structure and function changes in the myocardium of patients with type 2 DM, on the one hand, result from diabetic myocardiopathy induced by hyperglycemia and hyperinsulinemia and, on the other hand, result from an additional effect of progressive obesity and AH.
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