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Arterial-ventricular coupling in type 1 diabetes: arterial stiffness is associated with impaired global longitudinal strain in type 1 diabetes patients—the Thousand & 1 Study

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Abstract

Aims

Diabetes is associated with higher arterial stiffness—an early marker of cardiovascular disease. The coupling between arterial stiffness and myocardial function is still unresolved. We investigate associations between arterial stiffness and early myocardial impairment assessed with advanced echocardiography.

Methods

In 305 type 1 diabetes (T1D) patients without known heart disease and with normal left ventricular ejection fraction (LVEF) (biplane LVEF > 45%), we measured arterial stiffness as pulse wave velocity (PWV) and performed conventional and speckle-tracking echocardiography assessing global longitudinal strain (GLS) as a measure of systolic myocardial function. Associations between PWV and myocardial function were reported as standardized beta values from adjusted regression models including age, sex, mean arterial pressure, body mass index, HbA1c, diabetes duration, estimated glomerular filtration rate, degree of albuminuria, total cholesterol, heart rate and smoking.

Results

Patients were 54 (12) years [mean (SD)], 152 (50%) females, diabetes duration 31 (16) years, HbA1c 65 (12) mmol/mol, LVEF 58 (5) %, GLS −18.2 (2.6) % and PWV 10.2 (3.4) m/s. There was no association between PWV and LVEF (p = 0.93). Conversely, there was a highly significant association between PWV and GLS in crude and multivariable models (standardized β-coefficient 0.25, p < 0.001 and 0.16, p = 0.036, respectively). Also, diastolic function measured as E/e′ was highly associated with PWV in crude and multivariable models (standardized β-coefficient 0.43, p < 0.001 and 0.17, p = 0.016, respectively).

Conclusions

In T1D patients with normal LVEF and without known heart disease, higher arterial stiffness is independently associated with early systolic and diastolic myocardial impairment detectable by advanced echocardiography. Although unable to demonstrate causality, we display a relationship between diabetic angiopathy and diabetic cardiomyopathy (H-3-2009-139 and PROFIL-H-B-2009-056).

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Abbreviations

CVD:

Cardiovascular disease

GFR:

Glomerular filtration rate

GLS:

Global strain

IQR:

Interquartile range

PWV:

Pulse wave velocity

RAAS:

Renin–angiotensin–aldosterone system

TDI:

Tissue Doppler imaging

T1D:

Type 1 diabetes

UAER:

Urinary albumin excretion rate

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Acknowledgements

The Thousand & 1 study was supported by The European Foundation for the Study of Diabetes/Pfizer European Programme 2010 for Research into Cardiovascular Risk Reduction in Patients with Diabetes; and The Danish Heart Foundation (#: 12-04-R90-A3840-22725).

Author information

Authors and Affiliations

  1. Steno Diabetes Center Copenhagen, Niels Steensens Vej 1, 2820, Gentofte, Denmark

    Simone Theilade, Peter Rossing & Magnus T. Jensen

  2. Aarhus University, Aarhus, Denmark

    Peter Rossing

  3. University of Copenhagen, Copenhagen, Denmark

    Peter Rossing & Jan S. Jensen

  4. Department of Cardiology, Gentofte Hospital, Hellerup, Denmark

    Jan S. Jensen & Magnus T. Jensen

  5. Department of Internal Medicine, Holbaek Sygehus, Holbaek, Denmark

    Magnus T. Jensen

Authors
  1. Simone Theilade
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  2. Peter Rossing
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  4. Magnus T. Jensen
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Contributions

ST and MTJ researched the data, wrote the manuscript, contributed to the discussion and edited the manuscript. JSJ and PR contributed to the discussion and reviewed the manuscript.

Corresponding author

Correspondence to Simone Theilade.

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The authors have no conflict of interests.

Statement of human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Statement of informed consent

Informed consent was obtained from all patients for being included in the study.

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Theilade, S., Rossing, P., Jensen, J.S. et al. Arterial-ventricular coupling in type 1 diabetes: arterial stiffness is associated with impaired global longitudinal strain in type 1 diabetes patients—the Thousand & 1 Study. Acta Diabetol 55, 21–29 (2018). https://doi.org/10.1007/s00592-017-1062-2

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  • DOI: https://doi.org/10.1007/s00592-017-1062-2

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