Cortisol Levels Is Associated With Left Ventricular Diastolic Dysfunction in Diabetic Patients

Abstract

Abstract Introduction: Diabetes mellitus (DM) is a major cause of cardiovascular disease including heart failure with preserved ejection fraction (HFpEF), which is characterized by left ventricular diastolic dysfunction (LVDD). It is reported that Cushing’s syndrome is also associated with LVDD. The relationship between plasma cortisol concentration and LVDD, however, has not been investigated in patients with DM. Methods: In this study, 109 patients with DM and 104 patients with non-DM without overt heart failure were enrolled. Left ventricular function were assessed using echocardiography. The ratio of early diastolic velocity (E) from transmitral inflow to early diastolic velocity (e’) of tissue Doppler at mitral annulus (E/e’) was used as an index of diastolic function. Parameters of plasma cortisol concentration, glycemic control, lipid profile, treatment with anti-diabetic drugs and other clinical characteristics were evaluated, and their association with E/e’ determined. Patients taking steroids, undergoing dialysis treatment and with overt heart failure were excluded. Results: Univariate analysis showed that E/e’ was significantly correlated with age (p<0.001), duration of diabetes (p=0.039), systolic blood pressure (SBP) (p<0.001), eGFR (p=0.002), sodium glucose cotransporter 2 (SGLT2) inhibitor use (p<0.001) and cortisol (p=0.009) in patients with DM. Multivariate linear regression analysis showed that log E/e’ was positively correlated with age (p=0.018), log SBP (p= 0.005), eGFR (p=0.015), cortisol (p=0.028) and that log E/e’ was inversely with inhibitor use (p=0.018). There was no association between E/e’ and cortisol in patients with non-DM. Conclusions: Cortisol may be important in the development of LVDD in patients with DM.