Association between change of albuminuria and left ventricular diastolic function in type 2 diabetes

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Albuminuria is associated with left ventricular (LV) hypertrophy and diastolic dysfunction in patients with type 2 diabetes (T2DM), however the role of change in albuminuria and cardiac structure and function changes remain unclear. The aim of our study was to investigate the impact of change in albuminuria on changes of echocardiography parameters. Methods Patients with T2DM without cardiovascular disease at baseline were recruited from 2012 to 2016. All patients were performed with detailed echocardiography examination and received urine albumin to creatinine ratio (UACR) or 24-h urine albumin excretion (UAE) test at baseline and follow-up. Multivariable linear regression was applied to estimate the association between albuminuria and changes of echocardiography parameters. Results A total of 199 patients with T2DM were recruited (female, 47.2%; mean age, 61±10 years). Patients were divided into 4 albuminuria change groups according to baseline UACR or UAE level, 8 patients were in macroalbuminuria to none-macroalbuminuria group, 93 in none-macroalbuminuria-stable group, 68 in macroalbuminuria-stable group, and 30 in none-macroalbuminuria to macroalbuminuria group. There was a significant difference in the change of LV diastolic function (estimated by average E/e’) by albuminuria change groups (mean [SD] average E/e’: macroalbuminuria to none-macroalbuminuria, −1.40 [2.83]; none-macroalbuminuria-stable, 0.64 [2.16]; macroalbuminuria-stable, 0.97 [2.59]; non-macroalbuminuria to macroalbuminuria, 1.27 [2.71]; P=0.04). However, the changes in LV mass index (LVMi), ejection fraction (LVEF), E/A, and left atrial volume index (LAVi) between patients in different albuminuria change groups were insignificant. Multivariable regression demonstrated non-macroalbuminuria to macroalbuminuria was associated with increase in average E/e’, compared to patients with macroalbuminuria to none-macroalbuminuria (ß = 1.92, P < 0.05) after adjusting age, sex, hypertension, body mass index, eGFR, and diabetes duration. Conclusion The progression of none-macroalbuminuria to macroalbuminuria was associated with greater deterioration of LV diastolic function.