Left ventricular diastolic function in patients with impaired glucose tolerance and heart failure with low left ventricular ejection fraction

Abstract

Background: According to epidemiological studies, impaired glucose tolerance (IGT) is, in common with diabetes, related to an increased risk of cardiovascular disease, including heart failure (HF). Diastolic left ventricular function is one of the indices of HF severity, and a restrictive filling pattern is related to increased mortality and a need for heart transplantation.
The aim of the study was to evaluate left ventricular diastolic function in patients with IGT and HF due to left ventricular systolic dysfunction.
Material and methods: In 61 patients with HF and left ventricular ejection fraction (LVEF) < 45%, of mean age 50.5 ± 8.0 years, echocardiography with Doppler measurement of diastolic function parameters and oral glucose tolerance test (OGTT) were performed. Restrictive filling pattern (RFP) was diagnosed with E/A > 2 or between 1 and 2 and DTE ≤ 130 ms.
Results: IGT was diagnosed in 25 patients and normal glucose tolerance (NGT) in 36 patients. There were no significant differences in baseline clinical characteristics and LVEF between the two groups. In patients with IGT RFP was significantly more frequent (60 vs. 33%; p = 0.039) and the patients were in a higher NYHA class than those with NGT. In a multivariate regression analysis 2-h glucose level during OGTT was a significant predictor of E/A ratio independent of NYHA class, diuretic dose and LVEF.
Conclusion: Diastolic dysfunction and functional status according to NYHA class is worse in patients with HF due to left ventricular systolic dysfunction and IGT than in patients with NGT.