INCREASED RELATIVE WALL THICKNESS – A FREQUENT MARKER OF SUBCLINICAL CARDIAC TARGET ORGAN DAMAGE IN AFRICAN DIABETIC PATIENTS: PP.22.370

Abstract

Introduction: Diabetes and hypertension is associated with increased prevalence of abnormal left ventricular (LV) geometry in African-Americans. However, limited data is available on subclinical cardiac target organ damage in African diabetic patients living in Sub-Saharan Africa. Aim: To assess prevalence and covariates of abnormal LV geometry in type1 and type 2 diabetic out-patients attending Muhimbili National Hospital in Dar Es Salaam, Tanzania. Methods: Cardiovascular risk assessment and echocardiography was performed in 96 patients, 45 type 1 and 51 type 2 diabetics, mean age 38 years, 59% women. LV hypertrophy was taken as LV mass index >116 g/m2 in men and >104 g/m2 in women. Relative wall thickness (RWT) was calculated as the LV posterior wall thickness/internal radius ratio and considered increased if >0.43. LV geometry was defined from LV mass index and RWT in combination. Results: Compared to type 1 patients, type 2 diabetics had higher prevalence of hypertension (65 vs 7%) and abnormal LV geometry (67 vs 42%, both p < 0.01). In both groups concentric remodelling was the most prevalent type of abnormal LV geometry (Table 1). In univariate analysis, RWT was associated with higher age, blood pressure, LV mass and larger waist circumference and with lower eGFR, transmitral early velocity, early diastolic mitral annular tissue velocity (E’) and midwall fractional shortening (all p < 0.05). In multivariate linear regression (multiple R2 = 0.42, p < 0.01), higher RWT was independently associated with known hypertension (ß = 0.22), lower E’ (ß = -0.26) and higher LV mass (ß = 0.43, all p < 0.05). No independent association was found with renal function, diabetes control, obesity or systolic LV function. Conclusion: Concentric remodelling is common both in type 1 and type 2 diabetics. Increased RWT is primarily associated with hypertension and impaired diastolic LV function.