[OP.7B.07] IMPACT OF LEFT VENTRICULAR GEOMETRIC REMODELLING ON INSULIN-RESISTANCE-ASSOCIATED DECREASES IN DIASTOLIC FUNCTION IN A COMMUNITY SAMPLE. (September 2016)

• Record Type: Journal Article
• Authors: Norton, G.; Peterson, V.; Raymond, A.; Libhaber, C.D.; Millen, A.M.E.; Majane, O.H.I.; Maseko, M.J.; Woodiwiss, A.J.
• Is Part Of: Journal of hypertension. Volume 34:(2016) Supplement 2
• Publication Date: 2016-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000491562.19278.29
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: The impact of obesity or associated metabolic risk factors on left ventricular (LV) diastolic dysfunction (DD) may be modest in comparison to the effects of co-morbidities, such as increases in blood pressure (BP). We aimed to assess whether the impact of obesity (or associated insulin resistance) on LV diastolic function is enhanced by the presence of concentric LV remodelling. Design and method: Echocardiographic LV mass index (LVMI), relative wall thickness (RWT) and diastolic function (ratio of early-to-late transmitral blood flow velocity (E/A) and E / the mean of lateral and septal wall myocardial tissue lengthening at the level of the mitral annulus [e′] [E/e′] [n = 430]) were determined in 737 randomly recruited participants of a community-based study with a high prevalence of excess adiposity (43% obese). Results: Independent of LVMI and confounders, indexes of adiposity and the homeostasis model of insulin resistance (HOMA-IR) were modestly, but independently associated with E/A (p = 0.01), and E/e′ (p = 0.01). In addition, RWT was similarly modestly, but independently associated with E/A (p < 0.005), and E/e′ (p = 0.005). Importantly, independent of the individual terms and additional confounders (including LVMI), an interaction between HOMA-IR and RWT was related to E/A and E/e′ (p < 0.05). This translated into a significant independent relationship between HOMA-IR and E/A (partial r = −0.17, p < 0.002) and between HOMA-IR and E/e′ (partial r = 0.19, p < 0.01) in those with a RWT above the median for the sample, but a lack of relationship between HOMA-IR and E/A (partial r = 0.01, p = 0.79) and between HOMA-IR and E/e′ (partial r = −0.004, p = 0.98) in those with a RWT below the median for the sample. Similarly, HOMA-IR was independently associated with LV diastolic dysfunction in those with a RWT above (p < 0.05) but not below (p > 0.19) the median for the sample. Conclusions: The relationship between insulin resistance and LV diastolic function, and hence possibly the progression to heart failure with a preserved ejection fraction in obesity, may be markedly modified by the presence of concentric LV remodelling.