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Increased relative wall thickness is a marker of subclinical cardiac target-organ damage in African diabetic patients.

Chillo P, Lwakatare J, Lutale J, Gerdts E - Cardiovasc J Afr (2012)

Bottom Line: Overall, increased RWT was present in 58% of the patients.These associations were independent of gender, LV hypertrophy or renal dysfunction.Increased RWT is common among diabetic sub-Saharan Africans and is associated with hypertension and LV dysfunction.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Medicine, University of Bergen, Norway. pchillo2000@yahoo.co.uk

ABSTRACT

Objective: To assess the prevalence and covariates of abnormal left ventricular (LV) geometry in diabetic outpatients attending Muhimbili National Hospital in Dar es Salaam, Tanzania.

Methods: Echocardiography was performed in 61 type 1 and 123 type 2 diabetes patients. LV hypertrophy was taken as LV mass/height(2.7) > 49.2 g/m(2.7) in men and > 46.7 g/m(2.7) in women. Relative wall thickness (RWT) was calculated as the ratio of LV posterior wall thickness to end-diastolic radius and considered increased if ≥ 0.43. LV geometry was defined from LV mass index and RWT in combination.

Results: The most common abnormal LV geometries were concentric remodelling in type 1 (30%) and concentric hypertrophy in type 2 (36.7%) diabetes patients. Overall, increased RWT was present in 58% of the patients. In multivariate analyses, higher RWT was independently associated with hypertension, longer isovolumic relaxation time, lower stress-corrected midwall shortening and circumferential end-systolic stress, both in type 1 (multiple R(2) = 0.73) and type 2 diabetes patients (multiple R(2) = 0.66), both p < 0.001. These associations were independent of gender, LV hypertrophy or renal dysfunction.

Conclusion: Increased RWT is common among diabetic sub-Saharan Africans and is associated with hypertension and LV dysfunction.

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Related in: MedlinePlus

Receiver-operator characteristic (ROC) curve for the clinical risk score with best sensitivity (76%) and specificity (67%) in predicting high relative wall thickness. The cut-off value for the risk score (13 points) identified by the ROC analysis is indicated by an arrow. AUC = area under the curve, PPV = positive predictive value.
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Figure 4: Receiver-operator characteristic (ROC) curve for the clinical risk score with best sensitivity (76%) and specificity (67%) in predicting high relative wall thickness. The cut-off value for the risk score (13 points) identified by the ROC analysis is indicated by an arrow. AUC = area under the curve, PPV = positive predictive value.

Mentions: A risk score was calculated based on the beta coefficients in this model: risk score = 9x (type of diabetes) + 8x (albuminuria) + 9x (obesity) + 9x (hypertension). For each parameter included in the score, a value of 1 was assigned if the variable was present or 0 if it was absent. Therefore the individual risk score varied in this study population between 0 and 35 points. Based on the ROC curve analysis, the optimal cut-off point for the prediction of increased RWT was a score of 13 points (area under the curve = 0.77, p < 0.001, sensitivity = 76% and specificity = 67%). This risk score had a positive predictive value of 76% (Fig. 4).


Increased relative wall thickness is a marker of subclinical cardiac target-organ damage in African diabetic patients.

Chillo P, Lwakatare J, Lutale J, Gerdts E - Cardiovasc J Afr (2012)

Receiver-operator characteristic (ROC) curve for the clinical risk score with best sensitivity (76%) and specificity (67%) in predicting high relative wall thickness. The cut-off value for the risk score (13 points) identified by the ROC analysis is indicated by an arrow. AUC = area under the curve, PPV = positive predictive value.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3721891&req=5

Figure 4: Receiver-operator characteristic (ROC) curve for the clinical risk score with best sensitivity (76%) and specificity (67%) in predicting high relative wall thickness. The cut-off value for the risk score (13 points) identified by the ROC analysis is indicated by an arrow. AUC = area under the curve, PPV = positive predictive value.
Mentions: A risk score was calculated based on the beta coefficients in this model: risk score = 9x (type of diabetes) + 8x (albuminuria) + 9x (obesity) + 9x (hypertension). For each parameter included in the score, a value of 1 was assigned if the variable was present or 0 if it was absent. Therefore the individual risk score varied in this study population between 0 and 35 points. Based on the ROC curve analysis, the optimal cut-off point for the prediction of increased RWT was a score of 13 points (area under the curve = 0.77, p < 0.001, sensitivity = 76% and specificity = 67%). This risk score had a positive predictive value of 76% (Fig. 4).

Bottom Line: Overall, increased RWT was present in 58% of the patients.These associations were independent of gender, LV hypertrophy or renal dysfunction.Increased RWT is common among diabetic sub-Saharan Africans and is associated with hypertension and LV dysfunction.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Medicine, University of Bergen, Norway. pchillo2000@yahoo.co.uk

ABSTRACT

Objective: To assess the prevalence and covariates of abnormal left ventricular (LV) geometry in diabetic outpatients attending Muhimbili National Hospital in Dar es Salaam, Tanzania.

Methods: Echocardiography was performed in 61 type 1 and 123 type 2 diabetes patients. LV hypertrophy was taken as LV mass/height(2.7) > 49.2 g/m(2.7) in men and > 46.7 g/m(2.7) in women. Relative wall thickness (RWT) was calculated as the ratio of LV posterior wall thickness to end-diastolic radius and considered increased if ≥ 0.43. LV geometry was defined from LV mass index and RWT in combination.

Results: The most common abnormal LV geometries were concentric remodelling in type 1 (30%) and concentric hypertrophy in type 2 (36.7%) diabetes patients. Overall, increased RWT was present in 58% of the patients. In multivariate analyses, higher RWT was independently associated with hypertension, longer isovolumic relaxation time, lower stress-corrected midwall shortening and circumferential end-systolic stress, both in type 1 (multiple R(2) = 0.73) and type 2 diabetes patients (multiple R(2) = 0.66), both p < 0.001. These associations were independent of gender, LV hypertrophy or renal dysfunction.

Conclusion: Increased RWT is common among diabetic sub-Saharan Africans and is associated with hypertension and LV dysfunction.

Show MeSH
Related in: MedlinePlus