SA JOURNAL OF DIABETES & VASCULAR DISEASE RESEARCH ARTICLE VOLUME 20 NUMBER 1 • JUNE 2023 11 Statistical analysis Data are presented as number (n) and relative frequencies (%) for categorical variables and average (± standard deviation) for quantitative variables. Paired comparisons were carried out by Pearson’s chi-squared or Fischer’s exact test, as appropriate, for categorical variables, and multiple comparison of continuous variables (means and medians) by ANOVA and the H-test of Kruskal–Wallis. ANOVA tests, which were found to be significant at the threshold of p < 0.05, were supplemented by the Scheffé post hoc test, comparing the different groups two to two. The influence of HOMAIR and insulinaemia on the LV and diastolic parameters was investigated by linear regression in simple exploratory analysis, respectively. Correlation coefficients (r) were calculated to determine the degree of association between LV and diastolic parameters, and HOMAIR on one hand and insulinaemia on the other. When differences were observed between the ultrasound parameters and HOMAIR or insulin level, the effect of potential confounders was studied by adjustment in multiple linear regression. Finally, the determination coefficients (R2), were calculated to determine the degree of association between the ultrasound parameters of the left ventricle and HOMAIR or insulin level. The significance threshold was p < 0.05. Statistical analyses were performed using XLStat 2020 (Oxford, UK) and SPSS (Statistic Package for Social Sciences) 20 for Windows version 24 software (Chicago, USA). Results Socio-demographic and clinical characteristics of the patients according to LV geometry are shown in Table 1. Thirty-two (14.5%) patients (43.9 ± 9.1 years), 99 (45%) patients (52.4 ± 8.7 years) and 89 (40.5%) patients (53.1 ± 9.8 years) had normal LV geometry, concentric LV remodelling and concentric LVH, respectively. No cases of eccentric LV hypertrophy were found. Compared to participants with normal LV geometry, those with LVH were significantly older, obese, sedentary, insulin-resistant and had more often a history of hypertension, dyslipidaemia, hyperuricaemia, higher atherogenicity index and higher systolic blood pressure. Table 1 also shows that for a statistically similar age, high blood pressure history, lipid and uric acid profile, those with concentric LVH were more often obese, sedentary and insulin-resistant. However, those with concentric remodelling, compared to those with normal LV geometry, were more often older, sedentary, and had more often a history of hypertension and dyslipidaemia. The biological and echocardiographic characteristics are shown in Table 2. For similar total cholesterol and uric acid levels, participants with LVH had lower HDL-C levels, higher glycated haemoglobin and insulin levels, higher HOMAIR, thicker IVS, wider LVED and a higher LVM, with a lower LV ejection fraction than those with concentric remodelling. The E/A ratio was significantly lower for participants with concentric remodelling compared to those with normal LV geometry, and for those with LVH compared to normal LV geometry. As illustrated in Table 3, as well as in Figs 1 to 6, the correlation between HOMAIR and LVED, IVS, PWT, sum of wall thickness (SWT), LVM indexed to height2.7 (LVMIh), LVM indexed to body surface area (LVMIbsa), RWT and E-wave deceleration was 29.8, 41.6, 42.6, 44.1, 43.7, 44.5, 23.9 and 24.9%, respectively. Multiple linear regression (Table 4) demonstrated that insulin level and HOMAIR explained 46.8% of the increase in IVS (R2 = 0.468) and 30.9% of the increase in DT (R2 = 0.309). HOMAIR Table 1. Sociodemographic and clinical characteristics of patients according to LV geometry p-value normal All Normal LVG CR Concentric LVH p-value normal LVG vs concentric p-value concentric Variables (n = 220) (n = 32) (n = 99) (n = 89) LVG vs CR LVH LVH vs CRBMI Age (years) 51.5 ± 9.7 43.9 ± 9.1 52.4 ± 8.7 53.1 ± 9.8 < 0.001 < 0.001 0.605 Gender 0.527 0.746 0.674 Male 133 (60.5) 18 (56.3) 62 (62.6) 53 (59.6) Female 87 (39.5) 14 (43.8) 37 (37.4) 36 (40.4) T2DM 26 (11.8) 4 (12.5) 13 (13.1) 9 (10.1) 0.930 0.708 0.674 Known HTN 136 (61.8) 12 (37.5) 63 (63.6) 61 (68.5) 0.009 0.002 0.523 ND HTN 84 (38.2) 20 (62.5) 36 (36.4) 28 (31.5) 0.010 0.002 0.480 Overweight 86 (39.1) 15 (46.9) 49 (49.5) 22 (24.7) 0.799 0.020 0.258 Obesity 112 (50.9) 10 (31.3) 36 (36.4) 66 (74.2) 0.601 < 0.001 0.005 Abdominal obesity 97 (44.1) 5 (15.6) 37 (37.4) 55 (61.8) 0.022 < 0.001 < 0.001 Sedentary 123 (55.9) 6 (18.8) 45 (45.5) 72 (80.9) 0.007 < 0.001 < 0.001 Dyslipidaemia 173 (78.6) 18 (56.3) 79 (79.8) 76 (85.4) 0.009 0.007 0.315 High AI 93 (42.3) 8 (25.0) 39 (39.4) 46 (51.7) 0.141 0.010 0.092 Hyperuricaemia 51 (23.2) 3 (9.4) 19 (19.2) 29 (32.6) 0.199 0.011 0.036 Uncontrolled HTN 182 (82.7) 28 (87.5) 85 (85.9) 69 (77.5) 0.820 0.226 0.136 BMI (kg/cm2) 30.2 ± 5.0 28.2 ± 4.8 28.7 ± 4.0 32.6 ± 5.1 0.560 < 0.001 < 0.001 SBP (mmHg) 135.9 ± 7.9 132.2 ± 7.9 133.8 ± 6.9 138.9 ± 7.8 0.273 < 0.001 0.926 DBP (mmHg) 81.0 ± 9.0 79.8 ± 7.5 79.9 ± 9.7 82.5 ± 8.6 0.957 0.118 0.054 WC (cm) 103.3 ± 12.4 95.4 ± 9.8 100.4 ± 9.8 109.4 ± 13.1 0.013 < 0.001 < 0.001 HR (bpm) 67.9 ± 13.7 69.1 ± 17.2 70.5 ± 11.5 62.1 ± 13.5 0.600 0.021 < 0.001 Hyperinsulinaemia 19 (8.6) 2 (6.3) 8 (8.1) 9 (10.1) 0.740 0.523 0.634 Variables are presented as mean ± SD or n (%). LVG: left ventricular geometry; CR: concentric remodelling; LVH: left ventricular hypertrophy; T2D: type 2 diabetes mellitus; HTN: hypertension; ND HTN: newly diagnosed hypertension; AI: atherogenic index; BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; WC: waist circumference; HR: heart rate.
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