Abstract
Diabetes mellitus type 1 (DM1) is associated with aortic stiffening and left ventricular (LV) diastolic dysfunction, however the relationship between aortic stiffness and LV diastolic dysfunction in DM1 patients is still largely unknown. The purpose of this study was to evaluate whether an increased aortic stiffness, expressed by increased aortic pulse wave velocity (PWV), is associated with subclinical LV diastolic dysfunction and decreased left atrial (LA) compliance as assessed with speckle tracking strain analysis in patients with DM1. Aortic PWV was assessed with cardiovascular magnetic resonance in 41 DM1 patients. Patients underwent echocardiography for assessment of conventional LV diastolic function indices and LV and LA longitudinal strain and strain rate (SR) assessed with speckle tracking strain analysis. LV SR during the isovolumic relaxation period (SRIVR) and LA strain were recorded and the E-wave velocity to SRIVR velocity ratio (E/SRIVR) was calculated. Independent samples t test and multivariate linear regression analyses were used for statistical analyses. Aortic PWV significantly correlated with SRIVR (β = −0.71, p < 0.001), E/SRIVR (β = 0.61, p = 0.002) and LA strain (β = −0.47, p = 0.014), but not with conventional echocardiographic markers of diastolic function (all p > 0.10). In DM1 patients, aortic stiffness is inversely associated with sensitive markers of LV diastolic function and decrease in LA compliance as measured with echocardiographic speckle tracking strain analysis.
Similar content being viewed by others
References
Oxlund H, Rasmussen LM, Andreassen TT, Heickendorff L (1989) Increased aortic stiffness in patients with type 1 (insulin-dependent) diabetes mellitus. Diabetologia 32:748–752
Urbina EM, Wadwa RP, Davis C, Snively BM, Dolan LM, Daniels SR, Hamman RF, Dabelea D (2010) Prevalence of increased arterial stiffness in children with type 1 diabetes mellitus differs by measurement site and sex: the SEARCH for diabetes in Youth Study. J Pediatr 156(731–7):737
Karamitsos TD, Karvounis HI, Didangelos TP, Papadopoulos CE, Kachrimanidou MK, Selvanayagam JB, Parharidis GE (2008) Aortic elastic properties are related to left ventricular diastolic function in patients with type 1 diabetes mellitus. Cardiology 109:99–104
Schram MT, Chaturvedi N, Fuller JH, Stehouwer CD (2003) Pulse pressure is associated with age and cardiovascular disease in type 1 diabetes: the Eurodiab Prospective Complications Study. J Hypertens 21:2035–2044
Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG (2002) Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 106:2085–2090
Abhayaratna WP, Srikusalanukul W, Budge MM (2008) Aortic stiffness for the detection of preclinical left ventricular diastolic dysfunction: pulse wave velocity versus pulse pressure. J Hypertens 26:758–764
van Elderen SG, Brandts A, Westenberg JJ, van der Grond J, Tamsma JT, van Buchem MA, Romijn JA, Kroft LJ, Smit JW, de Roos A (2010) Aortic stiffness is associated with cardiac function and cerebral small vessel disease in patients with type 1 diabetes mellitus: assessment by magnetic resonance imaging. Eur Radiol 20:1132–1138
Grotenhuis HB, Westenberg JJ, Steendijk P, van der Geest RJ, Ottenkamp J, Bax JJ, Jukema JW, de Roos A (2009) Validation and reproducibility of aortic pulse wave velocity as assessed with velocity-encoded MRI. J Magn Reson Imaging 30:521–526
Kim DG, Lee KJ, Lee S, Jeong SY, Lee YS, Choi YJ, Yoon HS, Kim JH, Jeong KT, Park SC, Park M (2009) Feasibility of two-dimensional global longitudinal strain and strain rate imaging for the assessment of left atrial function: a study in subjects with a low probability of cardiovascular disease and normal exercise capacity. Echocardiography 26:1179–1187
Reisner SA, Lysyansky P, Agmon Y, Mutlak D, Lessick J, Friedman Z (2004) Global longitudinal strain: a novel index of left ventricular systolic function. J Am Soc Echocardiogr 17:630–633
Saraiva RM, Demirkol S, Buakhamsri A, Greenberg N, Popovic ZB, Thomas JD, Klein AL (2010) Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr 23:172–180
Vianna-Pinton R, Moreno CA, Baxter CM, Lee KS, Tsang TS, Appleton CP (2009) Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr 22:299–305
Ng AC, Delgado V, Bertini M, van der Meer RW, Rijzewijk LJ, Shanks M, Nucifora G, Smit JW, Diamant M, Romijn JA, de Roos A, Leung DY, Lamb HJ, Bax JJ (2009) Findings from left ventricular strain and strain rate imaging in asymptomatic patients with type 2 diabetes mellitus. Am J Cardiol 104:1398–1401
Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15:539–553
Lamb HJ, Doornbos J, van der Velde EA, Kruit MC, Reiber JH, de Roos A (1996) Echo planar MRI of the heart on a standard system: validation of measurements of left ventricular function and mass. J Comput Assist Tomogr 20:942–949
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 10:165–193
Dokainish H, Zoghbi WA, Lakkis NM, Al-Bakshy F, Dhir M, Quinones MA, Nagueh SF (2004) Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters. Circulation 109:2432–2439
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, John SM, Stewart W (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108
Shanks M, Ng AC, van de Veire NR, Antoni ML, Bertini M, Delgado V, Nucifora G, Holman ER, Choy JB, Leung DY, Schalij MJ, Bax JJ (2010) Incremental prognostic value of novel left ventricular diastolic indexes for prediction of clinical outcome in patients with ST-elevation myocardial infarction. Am J Cardiol 105:592–597
Wang J, Khoury DS, Thohan V, Torre-Amione G, Nagueh SF (2007) Global diastolic strain rate for the assessment of left ventricular relaxation and filling pressures. Circulation 115:1376–1383
Kurt M, Wang J, Torre-Amione G, Nagueh SF (2009) Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging 2:10–15
Westenberg JJ, Scholte AJ, Vaskova Z, van der Geest RJ, Groenink M, Labadie G, van den Boogaard PJ, Radonic T, Hilhorst-Hofstee Y, Mulder BJ, Kroft LJ, Reiber JH, de Roos A (2011) Age-related and regional changes of aortic stiffness in the Marfan syndrome: Assessment with velocity-encoded MRI. J Magn Reson Imaging 34:526–531
Cavalcante JL, Lima JA, Redheuil A, Al-Mallah MH (2011) Aortic stiffness current understanding and future directions. J Am Coll Cardiol 57:1511–1522
Vlachopoulos C, Aznaouridis K, Stefanadis C (2010) Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 55:1318–1327
van Elderen SG, Westenberg JJ, Brandts A, van der Meer RW, Romijn JA, Smit JW, de Roos A (2011) Increased aortic stiffness measured by MRI in patients with type 1 diabetes mellitus and relationship to renal function. AJR Am J Roentgenol 196:697–701
Brandts A, van Elderen SG, Tamsma JT, Smit JW, Kroft LJ, Lamb HJ, van der Meer RW, Westenberg JJ, de Roos A (2011) The effect of hypertension on aortic pulse wave velocity in type-1 diabetes mellitus patients: assessment with MRI. Int J Cardiovasc Imaging 28:543–550
Cecelja M, Chowienczyk P (2009) Dissociation of aortic pulse wave velocity with risk factors for cardiovascular disease other than hypertension: a systematic review. Hypertension 54:1328–1336
Leite-Moreira AF, Correia-Pinto J, Gillebert TC (1999) Afterload induced changes in myocardial relaxation: a mechanism for diastolic dysfunction. Cardiovasc Res 43:344–353
Aronson D (2003) Cross-linking of glycated collagen in the pathogenesis of arterial and myocardial stiffening of aging and diabetes. J Hypertens 21:3–12
Eren M, Gorgulu S, Uslu N, Celik S, Dagdeviren B, Tezel T (2004) Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension, diabetes, or both. Heart 90:37–43
Seyfeli E, Duru M, Saglam H, Akgul F, Kuvandik G, Kaya H, Yalcin F (2008) Association of left ventricular diastolic function abnormalities with aortic elastic properties in asymptomatic patients with type 2 diabetes mellitus. A tissue Doppler echocardiographic study. Int J Clin Pract 62:1358–1365
Nemeth ZK, Studinger P, Kiss I, Othmane TH, Nemcsik J, Fekete BC, Deak G, Egresits J, Szathmari M, Tisler A (2011) The method of distance measurement and torso length influences the relationship of pulse wave velocity to cardiovascular mortality. Am J Hypertens 24:155–161
Rajzer MW, Wojciechowska W, Klocek M, Palka I, Brzozowska-Kiszka M, Kawecka-Jaszcz K (2008) Comparison of aortic pulse wave velocity measured by three techniques: complior, sphygmocor and arteriograph. J Hypertens 26:2001–2007
Wang J, Nagueh SF (2009) Current perspectives on cardiac function in patients with diastolic heart failure. Circulation 119:1146–1157
Reiffel JA (2004) Is arterial stiffness a contributing factor to atrial fibrillation in patients with hypertension? A preliminary investigation. Am J Hypertens 17:213–216
Ravelli F, Allessie M (1997) Effects of atrial dilatation on refractory period and vulnerability to atrial fibrillation in the isolated Langendorff-perfused rabbit heart. Circulation 96:1686–1695
Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S, Rao SN, Blauer J, Fish EN, Dibella EV, Macleod RS, McGann C, Litwin SE, Marrouche NF (2010) Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging 3:231–239
Bramwell J, Hill A (1922) The velocity of the pulse wave in man. Proc R Soc Lond B 93:298–306
Hickson SS, Butlin M, Graves M, Taviani V, Avolio AP, McEniery CM, Wilkinson IB (2010) The relationship of age with regional aortic stiffness and diameter. JACC Cardiovasc Imaging 3:1247–1255
Acknowledgments
Foundation by the Netherlands Heart Foundation (Project UL 2009-4548) is gratefully acknowledged. Dr. Jos J.M. Westenberg is supported by an unconditional grant provided by Dr. Rainer Bluemm (Essen, Germany).
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
van Schinkel, L.D., Auger, D., van Elderen, S.G.C. et al. Aortic stiffness is related to left ventricular diastolic function in patients with diabetes mellitus type 1: assessment with MRI and speckle tracking strain analysis. Int J Cardiovasc Imaging 29, 633–641 (2013). https://doi.org/10.1007/s10554-012-0125-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-012-0125-2