Effect of Glycemic Control on Right Heart Functions in Type 2 Diabetes Mellitus Patients Free of Clinical Cardiovascular Disease
Abstract
Diabetes mellitus (DM) is one of the most common endocrine disorders. 90% percent of all diabetics are diagnosed with type 2 DM. DM is closely associated with various vascular diseases, and successful glycemic control prevents micro and macrovascular complications. Although there is data about the relation between glycemic control and left ventricle function, there is hardly any data about the relation between the right ventricular function. We analyzed the relationship between glycemic control and right ventricle function in type 2 DM patients free of clinical cardiovascular diseases (CVD). Patients were selected from the cardiology outpatient clinic. 53 patients formed the DM group; 51 patients formed the control group. All patients' demographic data were recorded. Biochemical tests and echocardiographic examinations were performed. RA and RV diameters were significantly higher in DM group (3.36±0.32 vs 3.13±0.34, P=0.015; 2.80±0.32 vs 2.56±0.22 P=0.005 respectively). Myocardial velocity during isovolumetric contraction (RV/IVV) and myocardial acceleration during Isovolumetric contraction (RV/IVA) were significantly lower in the DM group (14.4±3.17 vs 16.04±4.13 P=0,019; 3.25±0.75 vs 3.95±1,25 P=0.015). There was an intermediate negative correlation between RV/IVV and HBA1C (r=-0.406; P=0.036). HBA1C level was an independent risk factor for RV IVV (β=-0.406; P=0.036). It is shown that RA, RV diameter were significantly higher; RV/IVV and RV/IVA were significantly lower in diabetes mellitus patients free of CVD. Furthermore, there was a significant negative correlation between RV/IVV and HBA1C levels. HBA1C level was an independent risk factor for RV/IVV.
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16- Mozhgan Parsaee, Parvaneh Bahmanziari, Maryam Ardeshiri, Maryam Esmaeilzadeh. Obvious or Subclinical Right Ventricular Dysfunction in Diabetes Mellitus (Type II): An Echocardiographic Tissue Deformation Study. J Tehran Heart Cent. 2012 Nov; 7(4): 177–181
17- Shin-ichi Nunoda, Akira Genda, Norihiko Sugihara, Akira Nakayama, Sumio Mizuno, Riyoyu Takeda. Quantitative approach to the histopathology of the biopsied right ventricular myocardium in patients with diabetes mellitus Heart and Vessels February 1985; 1: 43–47
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21- David Suran, Andreja Sinkovic, Franjo Naji. Tissue Doppler imaging is a sensitive echocardiographic technique to detect subclinical systolic and diastolic dysfunction of both ventricles in type 1 diabetes mellitus. BMC Cardiovascular Disorders (2016) 16:72
22- Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, Rand L, Siebert C. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993; 329: 977–86
23- Ryden L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL; ESC Committee for Practice Guidelines (CPG), Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S; Document Reviewers, De Backer G, Sirnes PA, Ezquerra EA, Avogaro A, Badimon L, Baranova E, Baumgartner H, Betteridge J, Ceriello A, Fagard R, Funck-Brentano C, Gulba DC, Hasdai D, Hoes AW, Kjekshus JK, Knuuti J, Kolh P, Lev E, Mueller C, Neyses L, Nilsson PM, Perk J, Ponikowski P, Reiner Z, Sattar N, Schächinger V, Scheen A, Schirmer H, Strömberg A, Sudzhaeva S, Tamargo JL, Viigimaa M, Vlachopoulos C, Xuereb RG. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD) Eur Heart J 2013; 34: 3035–87
2- Liu Z, Fu C, Wang W, Xu B. Prevalence of chronic complications of type 2 diabetes mellitus in outpatients—a cross-sectional hospital-based survey in urban China. Health Qual Life Outcomes. 2010;8(1): 1
3-Malgorzata Poreba, Pawel Rostoff, Aleksander Siniarski, Magdalena Mostowik, Renata Golebiowska Wiatrak et al. The relationship between polyunsaturated fatty acid composition in serum phospholipids, systemic low-grade inflammation, and glycemic control in patients with type 2 diabetes and atherosclerotic cardiovascular disease. Cardiovasc Diabetol. 2018; 17: 29 doi: 10.1186/s12933-018-0672-5
4- Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Cardiovascular Disease in Diabetes Mellitus: Atherosclerotic Cardiovascular Disease and Heart Failure in Type 2 Diabetes Mellitus - Mechanisms, Management, and Clinical Considerations. Circulation. 2016 Jun 14; 133(24): 2459-502.
5- Goldman MP, Clark CJ, Craven TE, Davis RP, Williams TK, Velazquez-Ramirez G, Hurie JB, Edwards MS. Effect of Intensive Glycemic Control on Risk of Lower Extremity Amputation. J Am Coll Surg. 2018 Dec; 227(6): 596-604
6- Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, Wright AD, Turner RC, Holman R. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study BMJ. 2000 Aug 12; 321(7258): 412-9.
7- Schocken, D. D, Benjamin, E. J, Fonarow, G. C, Krumholz, H. M, Levy, D George A. Mensah, Jagat Narula, Eileen Stuart Shor, James B. Young, Yuling Hong. Prevention of heart failure: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation 2008; 117: 2544–2565.
8- Giulia Borghetti, Dirk von Lewinski, Deborah M. Eaton, Harald Sourij, Steven R. Diabetic Cardiomyopathy: Current and Future Therapies. Beyond Glycemic Control. Front Physiol. 2018 Oct 30; 9: 1514 doi: 10.3389/fphys.2018.01514
9- Tate M, Grieve D. J, Ritchie R. Are targeted therapies for diabetic cardiomyopathy on the horizon? Clin Sci (Lond). 2017 May 1; 131: 897-915
10- Giulia Borghetti, Dirk von Lewinski, Deborah M. Eaton, Harald Sourij, Steven R. Diabetic Cardiomyopathy: Current and Future Therapies. Beyond Glycemic Control. Front Physiol. 2018 Oct 30; 9: 1514 doi: 10.3389/fphys.2018.01514
11- Huynh K, Bernardo BC, Mcmullen JR, Ritchie R H. Diabetic cardiomyopathy: mechanisms and new treatment strategies targeting antioxidant signaling pathways. Pharmacol. Ther. 2014; 142: 375–415.
12- Jørgensen PG, Jensen MT, Biering-Sørensen T, Mogelvang R, Fritz-Hansen T, Vilsbol T, Peter R, Jensen JS. The burden of Uncontrolled Metabolic Risk Factors and Left Ventricular Structure and Function in Patients With Type 2 Diabetes Mellitus. J Am Heart Assoc. 2018 Oct 2;7(19): e008856. doi: 10.1161/JAHA.118.008856.
13- Peter Godsk Jørgensen, Magnus Thorsten Jensen, Tor Biering-Sørensen, Rasmus Mogelvang, Søren Galatius, Thomas Fritz-Hansen, Peter Rossing, Tina Vilsbøll, Jan Skov Jensen. Impact of type 2 diabetes and duration of type 2 diabetes on cardiac structure and function. Int J Cardiol. 2016 15; 221: 114-21.
14- Wu PY, Huang JC, Chen SC, Chen LI. Type 2 diabetes mellitus-related changes in left ventricular structure and function in patients with chronic kidney disease. Oncotarget. 2018 Feb 13; 9(18): 14661-14668.
15- Aepfelbacher FC, Yeon SB, Weinrauch LA, D' Elia J, Burger AJ. İmproved glycemic control induces regression of left ventricular mass in patients with type 1 diabetes mellitus. Int J Cardiol. 2004 Mar; 94(1): 47-51.
16- Mozhgan Parsaee, Parvaneh Bahmanziari, Maryam Ardeshiri, Maryam Esmaeilzadeh. Obvious or Subclinical Right Ventricular Dysfunction in Diabetes Mellitus (Type II): An Echocardiographic Tissue Deformation Study. J Tehran Heart Cent. 2012 Nov; 7(4): 177–181
17- Shin-ichi Nunoda, Akira Genda, Norihiko Sugihara, Akira Nakayama, Sumio Mizuno, Riyoyu Takeda. Quantitative approach to the histopathology of the biopsied right ventricular myocardium in patients with diabetes mellitus Heart and Vessels February 1985; 1: 43–47
18- Vogel M, Schmidt MR, Kristiansen SB, Cheung M, White PA, Sorensen K, Redington AN. Validation of the myocardial acceleration during isovolumic contraction as a novel index of right ventricular contractility: comparison with ventricular pressure-volume relations in an animal model. Circulation. 2002; 105: 1693–9.
19- Ertürk M, Öner E, Kalkan AK, Püşüroğlu H, Özyılmaz S. The role of isovolumic acceleration in predicting subclinical right and left ventricular systolic dysfunction in a patient with metabolic syndrome. Anatol J Cardiol. 2015;15:42–9.
20- Tayyareci Y, Tayyareci G, Tastan CP, Bayazit P, Nisanci Y. Early diagnosis of right ventricular systolic dysfunction by tissue Doppler-derived isovolumic myocardial acceleration in patients with chronic obstructive pulmonary disease. Echocardiography. 2009;26:1026–35
21- David Suran, Andreja Sinkovic, Franjo Naji. Tissue Doppler imaging is a sensitive echocardiographic technique to detect subclinical systolic and diastolic dysfunction of both ventricles in type 1 diabetes mellitus. BMC Cardiovascular Disorders (2016) 16:72
22- Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, Rand L, Siebert C. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993; 329: 977–86
23- Ryden L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL; ESC Committee for Practice Guidelines (CPG), Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S; Document Reviewers, De Backer G, Sirnes PA, Ezquerra EA, Avogaro A, Badimon L, Baranova E, Baumgartner H, Betteridge J, Ceriello A, Fagard R, Funck-Brentano C, Gulba DC, Hasdai D, Hoes AW, Kjekshus JK, Knuuti J, Kolh P, Lev E, Mueller C, Neyses L, Nilsson PM, Perk J, Ponikowski P, Reiner Z, Sattar N, Schächinger V, Scheen A, Schirmer H, Strömberg A, Sudzhaeva S, Tamargo JL, Viigimaa M, Vlachopoulos C, Xuereb RG. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD) Eur Heart J 2013; 34: 3035–87
| Files | ||
| Issue | Vol 58, No 3 (2020) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v58i3.3774 | |
| Keywords | ||
| Type 2 diabetes mellitus Right heart Isovolumetric acceleration Glycemic control Hemoglobin A1C (HBA1C) | ||
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How to Cite
1.
Ziyrek M. Effect of Glycemic Control on Right Heart Functions in Type 2 Diabetes Mellitus Patients Free of Clinical Cardiovascular Disease. Acta Med Iran. 2020;58(3):115-120.
