Determinants of echocardiographically measured left ventricular mass in diabetic patients with or without silent myocardial ischaemia

Left ventricular hypertrophy (LVH) is a recognized independent risk factor for cardiovascular morbidity and mortality. The purpose of this study was t o assess the determinants of left ventricular mass index (LVMI), according to the presence or absence of silent myocardial ischaemia (SMI), in diabeti c patients with at least two additional risk factors hut with no known coro nary artery disease. Eighty diabetic patients (14 Type 1 and 66 Type 2) wer e studied, and LVMI was measured echocardiographically. Three non-invasive tests (the ECG stress test, thallium-201 myocardial scintigraphy with intra venous dipyridamole infusion, and ambulatory 48-h ECG monitoring) were perf ormed on all patients. Forty-five percent of patients had LVH (LVMI greater than or equal to 110 g/m(2) in men and. greater than or equal to 106 g/m(2 ) in women). Twenty-six patients (37 %) had SMI assessed on at least one of the non-invasive tests, 7 of whom had significant coronary stenoses on ang iography. LVMI was significantly higher in patients with coronary stenoses on angiography than in those with SMI hut without coronary stenoses or in t hose without SMI (p < 0.05), and was correlated with systolic blood pressur e. In patients free of SMI, LVMI correlated with creatininemia. In patients with SMI and normal coronary arteries on angiography, LVMI correlated with the waist/hip girth ratio, the log urinary albumin excretion rate and the red blood cell filtration index la rigidity index). This study suggests tha t LVH is very frequent in diabetic patients and that the main factor contri buting to the increase of LVMI differs according to the presence or absence of SMI and coronary stenoses: volume load in patients free of SMI, microci rculatory disorders in those with SMI but with normal coronary arteries, an d blood pressure in those with coronary stenoses.