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Exp Clin Endocrinol Diabetes 2015; 123(09): 515-523
DOI: 10.1055/s-0035-1550052
Article
© Georg Thieme Verlag KG Stuttgart · New York

Low-grade Albuminuria Associated with Subclinical Left Ventricular Diastolic Dysfunction and Left Ventricular Remodeling

S. Yan   *
1   Department of Endocrinology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
,
F. Yao   *
1   Department of Endocrinology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
,
L. Huang
1   Department of Endocrinology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
,
Q. Ruan
2   Ultrasonic Department, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
,
X. Shen
1   Department of Endocrinology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
,
S. Zhang
1   Department of Endocrinology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
,
C. Huang
2   Ultrasonic Department, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
› Author Affiliations
Further Information

Publication History

received 08 January 2015
first decision 03 April 2015

accepted 07 May 2015

Publication Date:
27 July 2015 (online)

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Abstract

Aims: Low-grade albuminuria (LGA) has been shown to be associated with increased risk for cardiovascular disease. Our study investigated the relationship between normal urinary albumin-to-creatinine ratios (UACRs) and subclinical left ventricular (LV) diastolic dysfunction and remodeling in diabetics and non-diabetics.

Methods: A total of 888 diabetic and 208 non-diabetic patients with normal UACRs (< 30 mg/g) from Fuzhou, Fujian Province, China were examined. The subjects were stratified into quartiles based on their respective UACR levels. LV diastolic function was defined by early diastolic transmitral velocities (E)/average early diastolic annular velocities (average e), accompanied by average e. LV remodeling was defined by LV mass indexed to body surface area and relative wall thickness based on 2-dimensional and Doppler echocardiography.

Results: UACR was independently associated with cardiac diastolic function as defined by E/e and average e (OR=1.042, P=0.001) and LV remodeling (OR=1.037, P=0.001) in all participants. Diabetic patients in the highest quartile of UACR demonstrated a greater risk of developing LV diastolic dysfunction by a magnitude of 1.625 (OR=1.625, P=0.037) than patients in the lowest quartile; those in the third and highest quartiles demonstrated a greater risk of LV remodeling by a magnitude of 1.729–1.994 compared to the lowest quartile (OR=1.729, P=0.027 and OR=1.994, P=0.005, respectively). The association between UACR and subclinical diastolic dysfunction was most prevalent in younger, non-obese, non-hypertensive females or patients who had experienced diabetes for fewer than 10 years. The association between UACR and LV remodeling was most prevalent in non-obese, older males, in patients with normal low-density lipoprotein levels, in patients who had experienced diabetes for fewer than 10 years, and in patients without hypertension.

Conclusion: UACR was associated with subclinical LV diastolic dysfunction and remodeling in both patients with and without Type 2 diabetes. We conclude that LGA may also be a marker for subclinical cardiovascular damage in Type 2 diabetics.

Key words

type 2 diabetes mellitus - low-grade albuminuria - echocardiography - left ventricular diastolic dysfunction - left ventricular remodeling

* The first two authors contributed equally to this work.


 

  • References

  • 1 American Diabetes A . Standards of medical care in diabetes–2014. Diabetes care 2014; 37 (Suppl. 01) S14-S80
    CrossrefPubMedSearch in Google Scholar
  • 2 Gerstein HC, Mann JF, Yi Q et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. Jama 2001; 286: 421-426
    CrossrefPubMedSearch in Google Scholar
  • 3 Liu JE, Robbins DC, Palmieri V et al. Association of albuminuria with systolic and diastolic left ventricular dysfunction in type 2 diabetes: the Strong Heart Study. Journal of the American College of Cardiology 2003; 41: 2022-2028
    CrossrefPubMedSearch in Google Scholar
  • 4 Wachtell K, Palmieri V, Olsen MH et al. Urine albumin/creatinine ratio and echocardiographic left ventricular structure and function in hypertensive patients with electrocardiographic left ventricular hypertrophy: the LIFE study. Losartan Intervention for Endpoint Reduction. American heart journal 2002; 143: 319-326
    CrossrefPubMedSearch in Google Scholar
  • 5 Murussi M, Campagnolo N, Beck MO et al. High-normal levels of albuminuria predict the development of micro- and macroalbuminuria and increased mortality in Brazilian Type 2 diabetic patients: an 8-year follow-up study. Diabetic medicine: a journal of the British Diabetic Association 2007; 24: 1136-1142
    CrossrefPubMedSearch in Google Scholar
  • 6 Arnlov J, Evans JC, Meigs JB et al. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation 2005; 112: 969-975
    CrossrefPubMedSearch in Google Scholar
  • 7 Xu B, Dai M, Li M et al. Low-grade albuminuria is associated with peripheral artery disease in Chinese diabetic patients. Atherosclerosis 2014; 232: 285-288
    CrossrefPubMedSearch in Google Scholar
  • 8 Huang L, Zhang S, Liu D et al. Low-grade albuminuria associated with brachial-ankle pulse wave velocity in younger adults with type 2 diabetes mellitus in China. Diabetes/metabolism research and reviews 2014;
    PubMedSearch in Google Scholar
  • 9 Huang Y, Chen Y, Xu M et al. Low-grade albuminuria is associated with carotid intima-media thickness in Chinese type 2 diabetic patients. The Journal of clinical endocrinology and metabolism 2010; 95: 5122-5128
    CrossrefPubMedSearch in Google Scholar
  • 10 Blecker S, Matsushita K, Kottgen A et al. High-normal albuminuria and risk of heart failure in the community. American journal of kidney diseases: the official journal of the National Kidney Foundation 2011; 58: 47-55
    CrossrefPubMedSearch in Google Scholar
  • 11 Lieb W, Mayer B, Stritzke J et al. Association of low-grade urinary albumin excretion with left ventricular hypertrophy in the general population: the MONICA/KORA Augsburg Echocardiographic Substudy. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association – European Renal Association 2006; 21: 2780-2787
    PubMedSearch in Google Scholar
  • 12 Shah AM, Lam CS, Cheng S et al. The relationship between renal impairment and left ventricular structure, function, and ventricular-arterial interaction in hypertension. Journal of hypertension 2011; 29: 1829-1836
    CrossrefPubMedSearch in Google Scholar
  • 13 Katz DH, Selvaraj S, Aguilar FG et al. Association of low-grade albuminuria with adverse cardiac mechanics: findings from the hypertension genetic epidemiology network (HyperGEN) study. Circulation 2014; 129: 42-50
    CrossrefPubMedSearch in Google Scholar
  • 14 Devereux RB, Alonso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. The American journal of cardiology 1986; 57: 450-458
    CrossrefPubMedSearch in Google Scholar
  • 15 American Diabetes A . Standards of medical care in diabetes–2008. Diabetes care 2008; 31 (Suppl. 01) S12-S54
    CrossrefPubMedSearch in Google Scholar
  • 16 Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama 2003; 289: 2560-2572
    CrossrefPubMedSearch in Google Scholar
  • 17 Lang RM, Bierig M, Devereux RB et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 2005; 18: 1440-1463
    CrossrefPubMedSearch in Google Scholar
  • 18 McMurray JJV, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European heart journal 2012; 33: 1787-1847
    CrossrefPubMedSearch in Google Scholar
  • 19 [Anonymous] . Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization technical report series 1995; 854: 1-452
    PubMedSearch in Google Scholar
  • 20 Choo V. WHO reassesses appropriate body-mass index for Asian populations. Lancet 2002; 360: 235
    PubMedSearch in Google Scholar
  • 21 De Sutter J, De Backer J, Van de Veire N et al. Effects of age, gender, and left ventricular mass on septal mitral annulus velocity (E′) and the ratio of transmitral early peak velocity to E′ (E/E′). The American journal of cardiology 2005; 95: 1020-1023
    CrossrefPubMedSearch in Google Scholar
  • 22 Wu CK, Yang CY, Lin JW et al. The relationship among central obesity, systemic inflammation, and left ventricular diastolic dysfunction as determined by structural equation modeling. Obesity 2012; 20: 730-737
    CrossrefPubMedSearch in Google Scholar
  • 23 Kosmala W, Jedrzejuk D, Derzhko R et al. Left ventricular function impairment in patients with normal-weight obesity: contribution of abdominal fat deposition, profibrotic state, reduced insulin sensitivity, and proinflammatory activation. Circulation Cardiovascular imaging 2012; 5: 349-356
    CrossrefPubMedSearch in Google Scholar
  • 24 Kuznetsova T, Herbots L, Lopez B et al. Prevalence of left ventricular diastolic dysfunction in a general population. Circulation Heart failure 2009; 2: 105-112
    CrossrefPubMedSearch in Google Scholar
  • 25 Bulatov VA, Stenehjem A, Os I. Left ventricular mass assessed by electrocardiography and albumin excretion rate as a continuum in untreated essential hypertension. Journal of hypertension 2001; 19: 1473-1478
    CrossrefPubMedSearch in Google Scholar
  • 26 Ferrara AL, Vaccaro O, Cardoni O et al. Is there a relationship between left ventricular mass and plasma glucose and lipids independent of body mass index? Results of the Gubbio Study. Nutrition, metabolism, and cardiovascular diseases: NMCD 2003; 13: 126-132
    CrossrefPubMedSearch in Google Scholar
  • 27 Monfared A, Salari A, Mirbolok F et al. Left ventricular hypertrophy and microalbuminuria in patients with essential hypertension. Iranian journal of kidney diseases 2013; 7: 192-197
    PubMedSearch in Google Scholar
  • 28 Ichikawa R, Daimon M, Miyazaki T et al. Influencing factors on cardiac structure and function beyond glycemic control in patients with type 2 diabetes mellitus. Cardiovascular diabetology 2013; 12: 38
    CrossrefPubMedSearch in Google Scholar
  • 29 Silangei LK, Maro VP, Diefenthal H et al. Assessment of left ventricular geometrical patterns and function among hypertensive patients at a tertiary hospital, Northern Tanzania. BMC cardiovascular disorders 2012; 12: 109
    CrossrefPubMedSearch in Google Scholar
  • 30 Jensen JS. Renal and systemic transvascular albumin leakage in severe atherosclerosis. Arteriosclerosis, thrombosis, and vascular biology 1995; 15: 1324-1329
    CrossrefPubMedSearch in Google Scholar
  • 31 Meigs JB, D’Agostino Sr RB, Nathan DM et al. Longitudinal association of glycemia and microalbuminuria: the Framingham Offspring Study. Diabetes care 2002; 25: 977-983
    CrossrefPubMedSearch in Google Scholar
  • 32 Mykkanen L, Zaccaro DJ, Wagenknecht LE et al. Microalbuminuria is associated with insulin resistance in nondiabetic subjects: the insulin resistance atherosclerosis study. Diabetes 1998; 47: 793-800
    CrossrefPubMedSearch in Google Scholar
  • 33 Tseng CH. Lipid abnormalities associated with urinary albumin excretion rate in Taiwanese type 2 diabetic patients. Kidney international 2005; 67: 1547-1553
    CrossrefPubMedSearch in Google Scholar
  • 34 Stehouwer CD, Gall MA, Twisk JW et al. Increased urinary albumin excretion, endothelial dysfunction, and chronic low-grade inflammation in type 2 diabetes: progressive, interrelated, and independently associated with risk of death. Diabetes 2002; 51: 1157-1165
    CrossrefPubMedSearch in Google Scholar
  • 35 Ibsen H, Olsen MH, Wachtell K et al. Does albuminuria predict cardiovascular outcomes on treatment with losartan versus atenolol in patients with diabetes, hypertension, and left ventricular hypertrophy? The LIFE study. Diabetes care 2006; 29: 595-600
    CrossrefPubMedSearch in Google Scholar
  • 36 Li X, Jiang R, Kong H et al. Fasting Blood Glucose at Admission and Survival in Patients with Dilated Cardiomyopathy: a Single-center Cohort Study. Exp Clin Endocrinol Diabetes 2014; 122: 457-462
    Thieme ConnectPubMedSearch in Google Scholar
  • 37 Yan LQ, Cao XF, Zheng Y et al. Association of cystatin C-based glomerular filtration rate with SYNTAX score in patients with diabetes. Exp Clin Endocrinol Diabetes 2013; 121: 455-460
    Thieme ConnectPubMedSearch in Google Scholar