Left Ventricular Systolic Function in Asymptomatic Men Aged 65-75 Years, Relation to Insulin Resistance and Pre-Diabetes: A DANCAVAS Cross-Sectional Sub-Study.

AIM

Insulin resistance (IR) and hyperglycemia have been associated with increased risk of heart failure (HF) in patients with and without diabetes. Global longitudinel strain (GLS) has been shown to be superior in the detection of left ventricular (LV) systolic dysfunction when compared to ejection fraction (EF). In this study, we aimed to assess GLS in relation to IR and pre-diabetes.

METHOD

All participants underwent an echocardiography to assess LV systolic function using GLS. IR was evaluated using homeostatic model assessment for IR (HOMA-IR), and the participants were divided into tertiles based on their HOMA-IR values. An oral glucose tolerance test (OGTT) was performed to divide participants into normal glucose tolerance (NGT) and pre-diabetes. A multivariable linear regression model was used to assess GLS in relation to IR and glycemic groups.

RESULTS

In total, 359 men without significant coronary artery disease (CAD) and without diabetes were enrolled. Participants in the higher HOMA-IR tertile had significantly reduced GLS when compared with participants in the lower HOMA-IR tertile (-17.9% vs. -18.7%, < 0.01). A significant trend was observed towards reduced GLS with increasing HOMA-IR tertile (-trend 0.005). However, in the multivariable regression model, only waist-to-height-ratio (WH) (β 7.1 [95% CI 3.1-11.1, = 0.001) remained significantly associated with GLS, whereas HOMA-IR tertile and pre-diabetes were not.

CONCLUSIONS

In asymptomatic elderly men with no diabetes or CAD, neither IR nor pre-diabetes was associated with GLS in the adjusted regression model. Increased WH seems to be associated with reduced systolic function by GLS measurement.