RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE 12 VOLUME 20 NUMBER 1 • JUNE 2023 Table 2. Biological and ultrasound characteristics of patients according to LV geometry p-value normal Total Normal 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 CR Glycaemia (mmol/l) 5.8 ± 1.9 5.2 ± 1.2 5.4 ± 1.6 6.4 ± 2. 2 0.517 0.004 0.004 TC (mmol/l) 5.5 ± 1.0 5.0 ± 1.0 5.5 ± 1.0 5.5 ± 1.0 0.015 0.017 0.999 LDL-C (mmol/l) 3.7 ± 1.1 3.3 ± 1.1 3.7 ± 1.1 3.9 ± 1.1 0.076 0.009 0.215 Triglycerides (mmol/l) 1.14 ± 0.6 0.91 ± 0.4 1.11 ± 0.6 1.25 ± 0.6 0.081 0.003 0.112 HDL-C (mmol/l) 1.21 ± 0.3 1.27 ± 0.3 1.28 ± 0.4 1.13 ± 0.3 0.897 0.025 0.004 AI 4.8 ± 1.6 4.1 ± 0.9 4.7 ± 1.9 5.2 ± 1.6 0.088 0.004 0.054 HbA1c (%) 6.1 ± 1.3 5.7 ± 1.0 5.9 ± 1.0 6.4 ± 1.6 0.327 0.022 0.010 Creatinine (mmol/l) 84.5 ± 19.0 84.5 ± 18.1 84.3 ± 15.8 84.6 ± 22.5 0.952 0.982 0.915 Uric acid (mmol/l) 367.1 ± 94.6 317.1 ± 78.6 363.6 ± 90.7 388.2 ± 97.9 0.010 0.003 0.075 Insulin (mmol/l) 92.9 ± 41.8 68.2 ± 21.4 73.3 ± 25.8 123.2 ± 43.0 0.314 < 0.001 < 0.001 Calcium (mmol/l) 2.33 ± 0.2 2.32 ± 0.3 2.34 ± 0.2 2.30 ± 0.2 0. 667 0.674 0.173 Ionised calcium (mmol/l) 1.21 ± 0.2 1.24 ± 0.2 1.21 ± 0.1 1.20 ± 0.1 0.462 0.277 0.496 Phosphorus (mmol/l) 1.08 ± 0.2 1.14 ± 0.5 1.08 ± 0.2 1.06 ± 0.2 0.328 0.210 0.495 Hb (mg/dl) 13.4 ± 1.4 13.6 ± 1.6 13.4 ± 1.4 13.3 ± 1.3 0.499 0.295 0.614 HOMAIR 1.79 ± 0.8 1.42 ± 0.8 1.39 ± 0.5 2.37 ± 0.8 0.802 < 0.001 < 0.001 LVED (mm) 44.3 ± 4.6 45.7 ± 2.6 41.9 ± 4.0 46.5 ± 4.4 < 0.001 0.335 < 0.001 IVS (mm) 11.5 ± 1.7 9.0 ± 1.2 11.2 ± 1.3 12.7 ± 1.1 < 0.001 < 0.001 < 0.001 PWT (mm) 11.4 ± 1.6 9.0 ± 0.8 11.2 ± 1.3 12.5 ± 0.9 < 0.001 < 0.001 < 0.001 SWT 22.9 ± 3.1 18.1 ± 1.9 22.3 ± 2.4 25.2 ± 1.6 < 0.001 < 0.001 < 0.001 LVEF 64.6 ± 5.1 63.8 ± 4.4 65.5 ± 4.9 63.7 ± 5.4 0.083 0.925 0.018 LVM (g) 183.0 ± 48.4 139.5 ± 24.6 160.9 ± 34.3 222.8 ± 38.5 0.001 < 0.001 < 0.001 LVMIh (g/m2.7) 44.4 ± 11.1 34.4 ± 5.2 38.4 ± 6.4 54.7 ± 8.4 0.002 < 0.001 < 0.001 LVMIbsa (g/m2) 91.2 ± 20.8 71.9 ± 10.5 81.8 ± 15.1 108.6 ± 15.6 0.008 < 0.001 < 0.001 RWT 0.52 ± 0.1 0.40 ± 0.1 0.54 ± 0.1 0.55 ± 0.07 < 0.001 < 0.001 0.433 E (cm/s) 0.99 ± 0.7 1.31 ± 0.9 1.00 ± 0.5 0.86 ± 0.9 0.015 < 0.001 0.183 E/A ratio 0.99 ± 0.2 1.15 ± 0.1 0.75 ± 0.2 0.71 ± 0.2 < 0.001 < 0.001 0.173 DT (ms) 201.9 ± 40.0 178.1 ± 29.4 197.8 ± 39.2 215.3 ± 39.6 0.011 < 0.001 0.003 Sa (cm/s) 12.4 ± 1.4 12.9 ± 1.2 12.3 ± 1.2 12.4 ± 1.6 0.015 0.109 0.626 LAA (cm2) 15.7 ± 3.3 13.8 ± 1.9 14.9 ± 2.8 17.3 ± 3.5 0.040 < 0.001 < 0.001 sPAP (mmHg) 26.4 ± 2.9 24.5 ± 1.9 26.5 ± 2.7 27.0 ± 3.1 0.002 < 0.001 0.239 Variables are presented as mean ± SD or n (%). CR: concentric remodelling; TC: total cholesterol; LDL-C: low-density lipoprotein cholesterol; HD-C: high-density lipoprotein cholesterol; AI: atherogenic index; HbA1c: glycated haemoglobin; Hb: haemoglobin; HOMAIR: homeostatic model assessment for insulin resistance; LVED: left ventricular end-diastolic diameter; IVS: interventricular septum diameter; PWT: posterior wall thickness; SWT: sum of wall thickness; LVEF: left ventricular ejection fraction; LVM: left ventricular mass; LVMIh: left ventricular mass indexed to height2.7; LVMIbsa: left ventricular mass indexed to body surface area; RWT: relative wall thickness; E: peak E-wave velocity; DT: deceleration time; LAA: left atrial area; sPAP: systolic pulmonary arterial pressure. Table 3. Correlation between HOMAIR, insulinaemia and LV measurments and diastolic function parameters HOMAIR Insulin Variables r p-value r p-value LVED (mm) 0.298 < 0.001 0.273 < 0.001 IVS (mm) 0.416 < 0.001 0.468 < 0.001 PWT (mm) 0.426 < 0.001 0.463 < 0.001 SWT 0.441 < 0.001 0.489 < 0.001 LVMIh (g/m2.7) 0.437 < 0.001 0.448 < 0.001 LVMIbsa (g/m2) 0.445 < 0.001 0.472 < 0.001 RWT 0.239 < 0.001 0.288 < 0.001 DT (ms) 0.249 < 0.001 0.304 < 0.001 LVED: left ventricular end-diastolic diameter; IVS: interventricular septum; PWT: posterior wall thickness; SWT: sum of wall thickness; LVMIh: left ventricular mass indexed to height2.7; LVMbsa: left ventricular mass indexed to body surface area; RWT: relative wall thickness; DT: deceleration time. alone explained 30.1% of the increase in LVED (R2 = 0.301). Insulin alone explained 46.3% of the increase in PWT (R2 = 0.463) and 29.4% for RWT (R2 = 0.294). Discussion The purpose of this study was to evaluate the association of IR/ hyperinsulinaemia with components of Devereux’s formula and parameters of LV diastolic function. The results suggest that IR and hyperinsulinaemia have different effects on components of Devereux’s formula, depending on whether they act in synergy or in isolation. IR alone appears to increase LVM only by dilation of LVED, while hyperinsulinaemia alone may increase LVM by a trophic effect on the posterior wall. Only their synergistic action seems to have a trophic effect on the IVS but also a deleterious effect on diastolic function. These findings make the thorny question of ‘the egg and the chicken’ between IR and hyperinsulinaemia appear as a watermark. The cause–effect relationship between IR and hyperinsulinaemia is still debated, since these two conditions are closely associated. It is possible that the two conditions are related by a reciprocal causal relationship, since there are plausible physiopathological explanations justifying the role of the ‘chicken or egg’ for each of the conditions, respectively.
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