P318Additive effect of noninsulin dependent diabetes mellitus on left ventricular mass in systemic hypertension. Assessment with cardiac magnetic resonance


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Abstract

Non-insulin-dependent diabetes mellitus (NIDDM) may increase left ventricular mass (LVM). NIDDM is a frequent finding in patients with systemic hypertension (HT). Our objective was to quantify with cardiac magnetic resonance (CMR) the additional effect of NIDDM on LVM in hypertensive patients.Methods: All hypertensive patients aged 30-80 yrs referred for a stress myocardial perfusion CMR between january 2008 and december 2010 were studied. Cardiovascular risk factors were recorded. The CMR protocol included TrueFISP cine sequences in the usual views, myocardial perfusion sequences after administration of iv dipyridamole (0.4mg/Kg) and late gadolinium enhancement sequences. Patients with signs of necrosis on CMR or with features suggestive of other type of cardiomyopathy or secondary hypertension were excluded. Hypertensive patients were divided according to the presence (HD) or absence (H) of NIDDM.Results: 875 hypertensive patients were included, 585 H (51% males, 65±11yrs) and 290 HD (45% males, 67±10yrs). Two-way ANOVA (factors: group H/HD, gender; covariables: age, body mass index, duration of HT) was done. Group HD showed increased septum and posterior wall diastolic thickness (SD, PWD, mm), LVM (g), indexed LVM (LVMi, g/m2) and relative wall mass (RWM, g/mL). Chi-square analysis showed that group HD had a higher risk of developing a concentric remodelling pattern (CR, OR= 1.69) and concentric left ventricular hypertrophy (cLVH, OR= 1.71), while group H had a higher risk of developing eccentric hypertrophy (eLVH, OR= 1.78). Lineal regression analysis showed that, in hypertensive patients, concomitant NIDDM induced a mean further increase of 6gr in LVM.Conclusions: In hypertensive patients, concomitant NIDDM causes a significant further increase in LVM, as well as a more severe pattern of LV remodelling and of LV hypertrophy. These findings may contribute to explain the worse prognosis of hypertensive patients with concomitant NIDDM.

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