Low-grade Albuminuria Associated With Left Ventricular Diastolic Function And Left Ventricular Remodeling In Type 2 Diabetics

Background: Low-grade albuminuria(LGA)(<30 mg/g) has been shown to be associated with increased risk for cardiovascular disease. Our retrospective study aimed to investigate the association between normal urinary albumin-to-creatinine ratios(UACRs) and left ventricular(LV) diastolic function and remodeling in type 2 diabetics.Methods: We conducted a retrospective study that enrolled 465 males and 423 females with type 2 diabetes and normal UACRs(<30 mg/g) from the First Affiliated Hospital of Fujian Medical University between June 2010 and September 2014. The subjects were stratified into quartiles based on UACR levels(0.9-5.87, 5.87- 9.17, 9.17-15.30, 15.30-30.00 mg/g). Early diastolic transmitral velocities(E), average early diastolic annular velocities(average e), LV mass indexed to body surface area(LVMI) and relative wall thickness(RWT) were measured and calculated based on two-dimensional and Doppler echocardiography. E/e accompanied with average e defined LV diastolic dysfunction and LV remodeling was defined by LVMI and RWT.Results:1. The frequencies of subclinical left ventricular diastolic dysfunction among type 2 diabetic patients in the four quartiles were Q1(42.3%)<Q2(52.7%)<Q3(56.8%)<Q4(65.3%)(P<0.001).The frequencies of left ventricular remodeling in the four quartiles were Q1(17.6%)<Q2(27.0%)<Q3(30.6%)<Q4(35.1%)(P<0.001). The frequencies of subclinical left ventricular diastolic dysfunction and left ventricular remodeling were increased with UACR quartiles in type 2 diabetic patients.2. UACR was significantly correlated with average e, E/e and LVMI(β=-0.004, p<0.001;β= 0.081, p<0.001;β= 0.383, p<0.001, respectively) after age, sex, duration of diabetes, SBP, DBP, e GFR, Hb A1 c and BMI were adjusted. UACR was notsignificantly correlated with RWT after adjustment.3. After adjusting for age, sex, duration of diabetes, SBP, DBP, eGFR, HbA1 c, BMI, smoking and drinking status and the use of drugs, fully adjusted logistic regressions showed that patients in the highest quartile of UACR had 1.625-fold risk of LV diastolic dysfunction(OR=1.625, 95%CI=1.029- 2.568,P=0.037) and those in the third and highest quartiles had 1.729 and 1.994 times to have LV remodeling compared with the lowest one(OR=1.729, 95%CI=1.064-2.810, P=0.027; OR=1.994, 95%CI=1.232-3.227, P=0.005).4.The association between UACR and subclinical diastolic dysfunction still persisted in younger than 60 years old, non-obese, non-hypertensive females or those had diabetes for less than 10 years. The association between UACR and LV remodeling still persisted in non-obese, elder males, in those with normal low-density lipoprotein levels, in those with duration of diabetes less than 10 years, or in those without hypertension.Conclusions:UACR was associated with subclinical LV diastolic dysfunction and LV remodeling in type 2 diabetics. LGA may be a marker for subclinical cardiovascular damage in type 2 diabetics.