CHAPTER 19: Diabetes and Hypertension

DIABETES MELLITUS

• Metabolic syndrome:

  • - Elevated fasting glucose.

  • - Elevated blood pressure.

  • - Elevated waist circumference.

  • - Elevated triglycerides.

  • - Reduced high-density lipoprotein cholesterol.

• Echo in a diabetic may reveal wall motion abnormalities of a previously undiagnosed silent myocardial infarction.

• Diabetics with coronary artery disease may be referred for complete revascularization with bypass surgery, rather than partial revascularization with a stent.

• Echo assessment of left ventricular systolic and diastolic function, as well as a search for regional left ventricular wall motion abnormalities, may help in this decision.

Sources

• Ernande L, Bergerot C, Girerd N, et al. Longitudinal myocardial strain alteration is associated with left ventricular remodeling in asymptomatic patients with type 2 diabetes mellitus. J Am Soc Echocardiogr. 2014;27:479–488.

• Hare JL, Hordern MD, Leano R, et al. Application of an exercise intervention on the evolution of diastolic dysfunction in patients with diabetes mellitus: efficacy and effectiveness. Circ Heart Fail. 2011;4:441–449.

• Hwang YC, Jee JF, Kang M, et al. Metabolic syndrome and insulin resistance are associated with abnormal left ventricular diastolic function and structure independent of blood pressure and fasting plasma glucose level. Int J Cardiol. 2012;159:107–111.

• Kosmala W, Przewlocka-Kosmala M, Wojnalowicz A, et al. Integrated backscatter as a fibrosis marker in the metabolic syndrome: association with biochemical evidence of fibrosis and left ventricular dysfunction. Eur Heart J Cardiovasc Imaging. 2012;13:459–467.

• Seferović PM, Paulus WJ. Clinical diabetic cardiomyopathy: a two-faced disease with restrictive and dilated phenotypes. Eur Heart J. 2015;36:1718–1727.

• Shindler DM, Kostis JB, Yusuf S, et al. Diabetes mellitus, a predictor of morbidity and mortality in the Studies of Left Ventricular Dysfunction (SOLVD) Trials and Registry. Am J Cardiol. 1996;77:1017–1020.

• Zoroufian A, Razmi T, Taghavi-Shavazi M, et al. Evaluation of subclinical left ventricular dysfunction in diabetic patients: longitudinal strain velocities and left ventricular dyssynchrony by two-dimensional speckle tracking echocardiography study. Echocardiography. 2014;31:456–463.

HYPERTENSIVE HEART DISEASE

• Left ventricular hypertrophy (LVH) is used clinically as an indicator of cardiac end-organ damage due to hypertension.

• It is important for the sonographer to learn to identify the classic unmistakable ECG of LVH.

• Once LVH develops on the ECG, it is a permanent marker of hypertensive heart disease.

• Treatment of hypertension may favorably affect the extent of LVH.

• It is possible to compare available sequential echo studies to look for changes in LVH.

• M-mode calculation of LV mass had been used extensively in the past as a simple measure of reversibility.

• Pitfall: The calculated M-mode changes in LV mass are valid only if the left ventricle is not dilated due to associated valvular ...