IMPAIRED LEFT-VENTRICULAR DIASTOLIC FUNCTION AND VASCULAR POSTISCHEMIC VASODILATION ASSOCIATED WITH MICROALBUMINURIA IN IDDM PATIENTS

OBJECTIVE - Microalbuminuria is considered an important predictor of c ardiovascular events in diabetic patients. In this study, a possible a ssociation of microalbuminuria with significant changes in left ventri cular (LV) morphology and function and generalized vascular dysfunctio n was analyzed in insulin-dependent diabetes mellitus (IDDM) patients without hy pertension, coronary artery disease, or autonomic dysfuncti on. RESEARCH DESIGN AND METHODS - Thirty-four young long-term IDDM pat ients, 16 with and 18 without microalbuminuria, and 20 control subject s were studied. LV systolic function and wall thickness were evaluated by M-mode echocardiography. LV diastolic function was studied using a combined echo-Doppler and phonocardiographic technique. The hyperemic response to forearm ischemia was measured by strain-gauge plethysmogr aphy. All patients underwent 24-h ambulatory blood pressure monitoring . RESULTS - LV mass index and wall thickness:radius ratio were signifi cantly higher in microalbuminuric patients. LV relaxation was signific antly impaired in both diabetic groups compared with control subjects, moreover, this impairment was significantly greater in microalbuminur ic than in normoalbuminuric patients. In microalbuminuric patients, fo rearm postischemic vasodilation was also significantly lower and mean awake diastolic blood pressure (dBP) was significantly higher than in the other two groups. CONCLUSIONS - Our data suggest that microalbumin uria is associated with significant changes in LV morphology, a more s evere impairment of cardiac diastolic function, altered vascular dilat ory capacity, and higher daytime dBP. Therefore, microalbuminuric pati ents should be considered to have a higher risk of cardiovascular comp lications and be kept under closer surveillance.