Impaired fasting glucose and left ventricular diastolic dysfunction in middle-age adults: A retrospective cross-sectional analysis of 2971 subjects

Background: Left ventricular (LV) diastolic dysfunction (LVDD) is a well-established and early echocardiographic characteristic of diabetic cardiomyopathy. However, there are limited data on the association between impaired fasting glucose (IFG) and LVDD. Objective: To determine whether IFG is associated with LVDD among middle age adults. Methods: Amongst 3781 subjects screened in an annual health survey program and referred for an echocardiogram, 2971 individuals without LV systolic dysfunction or valvular heart disease were selected. Mean age of study population was 59±12years and 75% were men. The subjects were categorized into three groups: euglycemia (N=2025), IFG (N=534) and diabetes mellitus (DM; N=412). Doppler echocardiography readers were blinded to glycemic state. Subjects with impaired LV relaxation, pseudo-normal or restrictive filling patterns were defined as having LVDD. Results: LVDD was diagnosed in 574 (19%) of subjects and it was more prevalent among patients with IFG and DM than in euglycemic individuals (27, 30 and 15%, respectively; p<0.001). Patients with IFG and DM had lower ratios of early (E) to late (A) trans-mitral flow (0.9±0.3 and 0.9±0.3 vs. 1.1±0.4, respectively, p<0.001). LV hypertrophy (LVH) was also more prevalent among patients with IFG and DM (11 and 18%, respectively, vs. 9%; p<0.001). Multivariate binary logistic regression model adjusted to age, gender, obesity, LVH, renal function, total, high and low density lipoprotein cholesterol, triglycerides, ischemic heart disease, hypertension and LV ejection fraction showed that patients with IFG were 43% more likely to have LVDD compared with euglycemic subjects (95% confidence interval 1.12-1.83, p=0.004). Conclusions: IFG is independently associated with a significant increase in the likelihood for the presence of LVDD in middle aged adults.