Impact of type 2 diabetes mellitus on left ventricular diastolic function in patients with essential hypertension: evaluation by volume-time curve of cardiac magnetic resonance

Background: Essential hypertension and type 2 diabetes mellitus (T2DM) are two common chronic diseases that often coexist, and both of these diseases can cause heart damage. However, the additive effects of essential hypertension complicated with T2DM on left ventricle (LV) diastolic function have not been fully illustrated. This study aims to investigate whether T2DM affects the diastolic function of the LV in patients with essential hypertension using the volume-time curve from cardiac magnetic resonance (CMR). Methods: A total of 124 essential hypertension patients, including 48 with T2DM [HTN(T2DM+) group] and 76 without T2DM [HTN(T2DM-) group], and 52 normal controls who underwent CMR scans were included in this study. LV volume-time curve parameters, including the peak ejection rate (PER), time to peak ejection rate (PET), peak filling rate (PFR), time to peak filling rate from end-systole (PFT), PER normalized to end-diastolic volume (PER/EDV), and PFR normalized to EDV (PFR/EDV), were measured and compared among the three groups. Multivariate linear regression analyses were performed to determine the effects of T2DM on LV diastolic dysfunction in patients with hypertension. Pearson correlation was used to analyse the correlation between the volume-time curve and myocardial strain parameters. Results: PFR and PFR/EDV decreased from the control group, through HTN(T2DM -), to HTN(T2DM +/-) group. PFT in the HTN(T2DM-) group and HTN(T2DM+) group was significantly longer than that in the control group. The LV remodelling index in the HTN(T2DM-) and HTN(T2DM+) groups was higher than that in the normal control group, but there was no significant difference between the HTN(T2DM -) and HTN(T2DM+) groups. Multiple regression analyses controlling for covariates of systolic blood pressure, age, sex, and heart rate demonstrated that T2DM was independently associated with PFR/EDV (beta = 0.252, p <0.05). The volume-time curve method has good repeatability, and there is a significant correlation between volume-time curve parameters (PER/EDV and PFR/EDV) and myocardial peak strain rate, especially circumferential peak strain rate, which exhibited the highest correlation (r = - 0.756 similar to 0.795). Conclusions: T2DM exacerbates LV diastolic dysfunction in patients with essential hypertension. The LV filling model changes reflected by the CMR volume-time curve could provide more information for early clinical intervention.

Automated summary

This study aimed to investigate whether T2DM affects the diastolic function of the LV in patients with essential hypertension. The results demonstrate that T2DM exacerbates LV diastolic dysfunction in patients with essential hypertension, and the changes in the LV filling model reflected by the CMR volume-time curve could provide more information for early clinical intervention.