Abstract
BackgroundIn comparison to the well established changes in compliance that occur at the large vessel level in diabetes, much less is known about the changes in compliance of the cardiovascular system at the end-organ level. The aim of this study was therefore to examine whether there was a correlation between resistance of the intrarenal arteries of the kidney and compliance of the left ventricle, as estimated by measurements of diastolic function, in subjects with type 2 diabetes.MethodsWe studied 167 unselected clinic patients with type 2 diabetes with a kidney duplex scan to estimate intrarenal vascular resistance, i.e. the resistance index (RI = peak systolic velocity-minimum diastolic velocity/peak systolic velocity) and a transthoracic echocardiogram (TTE) employing tissue doppler studies to document diastolic and systolic ventricular function.ResultsRenal RI was significantly higher in subjects with diastolic dysfunction (0.72 ± 0.05) when compared with those who had a normal TTE examination (0.66 ± 0.06, p < 0.01). Renal RI values were correlated with markers of diastolic dysfunction including the E/Vp ratio (r = 0.41, p < 0.001), left atrial area (r = 0.36, p < 0.001), the E/A ratio (r = 0.36, p < 0.001) and the E/E' ratio (r = 0.31, p < 0.001). These associations were independent of systolic function, hypertension, the presence and severity of chronic kidney disease, the use of renin-angiotensin inhibitors and other potentially confounding variables.ConclusionIncreasing vascular resistance of the intrarenal arteries was associated with markers of diastolic dysfunction in subjects with type 2 diabetes. These findings are consistent with the hypothesis that vascular and cardiac stiffening in diabetes are manifestations of common pathophysiological mechanisms.
Highlights
In comparison to the well established changes in compliance that occur at the large vessel level in diabetes, much less is known about the changes in compliance of the cardiovascular system at the end-organ level
Data for categorical variables are expressed as proportions. * p < 0.05, ** p < 0.01 vs individuals with normal cardiac function on transthoracic echocardiogram (TTE), Subjects were further stratified according to results of their TTE examination
This study demonstrates that worsening indices of diastolic function in subjects with type 2 diabetes parallels increases in resistance of the intrarenal vessels
Summary
In comparison to the well established changes in compliance that occur at the large vessel level in diabetes, much less is known about the changes in compliance of the cardiovascular system at the end-organ level. The aim of this study was to examine whether there was a correlation between resistance of the intrarenal arteries of the kidney and compliance of the left ventricle, as estimated by measurements of diastolic function, in subjects with type 2 diabetes. Diabetes is associated with the premature development of large vessel arterial stiffness [1]. Increased arterial stiffness is known to be associated with cardiac and kidney dysfunction and is a powerful risk factor for early mortality [2]. Recent epidemiological studies show that diastolic dysfunction is an independent risk factor for cardiac death [5]. We have shown that increased resistance of the intrarenal arteries is associated with a reduced glomerular filtration rate (GFR), an independent predictor of cardiac mortality [6,7,8]
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