Low-grade Albuminuria Associated with Subclinical Left Ventricular Diastolic Dysfunction and Left Ventricular Remodeling.

Abstract

Low-grade albuminuria (LGA) has been shown to be associated with increased risk for cardiovascular disease. Our study investigated the relationship between normal urinary albumin-to-creatinine ratios (UACRs) and subclinical left ventricular (LV) diastolic dysfunction and remodeling in diabetics and non-diabetics. A total of 888 diabetic and 208 non-diabetic patients with normal UACRs (< 30 mg/g) from Fuzhou, Fujian Province, China were examined. The subjects were stratified into quartiles based on their respective UACR levels. LV diastolic function was defined by early diastolic transmitral velocities (E)/average early diastolic annular velocities (average e), accompanied by average e. LV remodeling was defined by LV mass indexed to body surface area and relative wall thickness based on 2-dimensional and Doppler echocardiography. UACR was independently associated with cardiac diastolic function as defined by E/e and average e (OR=1.042, P=0.001) and LV remodeling (OR=1.037, P=0.001) in all participants. Diabetic patients in the highest quartile of UACR demonstrated a greater risk of developing LV diastolic dysfunction by a magnitude of 1.625 (OR=1.625, P=0.037) than patients in the lowest quartile; those in the third and highest quartiles demonstrated a greater risk of LV remodeling by a magnitude of 1.729-1.994 compared to the lowest quartile (OR=1.729, P=0.027 and OR=1.994, P=0.005, respectively). The association between UACR and subclinical diastolic dysfunction was most prevalent in younger, non-obese, non-hypertensive females or patients who had experienced diabetes for fewer than 10 years. The association between UACR and LV remodeling was most prevalent in non-obese, older males, in patients with normal low-density lipoprotein levels, in patients who had experienced diabetes for fewer than 10 years, and in patients without hypertension. UACR was associated with subclinical LV diastolic dysfunction and remodeling in both patients with and without Type 2 diabetes. We conclude that LGA may also be a marker for subclinical cardiovascular damage in Type 2 diabetics.