Albuminuria is independently associated with preclinical left ventricular systolic dysfunction: The TESEO study

Table 1 Demographic and clinical characteristics of the 193 subjects with type 2 diabetes recruited in the study, mean ± SD

Characteristics	DM2 (n = 193)
Clinical characteristics
Age (year)	60.64 ± 8.11
Male gender (%)	57.0
Diabetes duration (year)	3.84 ± 4.92
BMI (kg/m2)	30.96 ± 5.51
BMI ≥ 30 (%)	52.3
WC (cm)	109.17 ± 11.80
SBP (mmHg)	135.9 ± 16.3
DBP (mmHg)	82.7 ± 9.8
Hypertension (%)	89.6
Smoking status (%)
No smokers	39.4
Active smokers	20.7
Former smokers	39.9
Biochemistry
HbA1c (%)	6.48 ± 1.00
Total cholesterol (mg/dL)	175.74 ± 39.56
LDL-cholesterol (mg/dL)	99.71 ± 34.54
HDL-cholesterol (mg/dL)	51.72 ± 12.72
Triglycerides (mg/dL)	114.8 (86.0-147.0)
ACR (mg/mmol)	1.047 (0.565-1.360)
eGFR (mL/minute/1.73 m2)	87.82 ± 15.87
NTpro-BNP (ng/L)	46.0 (26.0-85.0)
Uric acid (mg/L)	5.45 ± 1.56
Glucose lowering medication (%)
Metformin	85.0
DDP-4 inhibitors	10.9
SGLT-2 inhibitors	23.8
GLP-1 receptor agonists	28.0
Insulin	7.3

Data are expressed as mean ± SD, percentage or geometric mean (25%-75%) for log-transformed data. DM2: Type 2 diabetes; BMI: Body mass index; WC: Waist circumference; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; HbA1c: Glycated haemoglobin A1c; LDL: Low-density lipoprotein; HDL: High-density lipoprotein; eGFR: Estimated glomerular filtration rate; ACR: Albumin-creatinine ratio; NTpro-BNP: N-terminal pro b-type natriuretic peptide; DDP-4: Dipeptidyl peptidase-4; SGLT-2: Sodium-glucose cotransporter-2; GLP-1: Glucagon-like peptide-1.

Table 2 Demographic and clinical characteristics of 193 type 2 diabetes subjects stratified by global longitudinal strain-left ventricular systolic dysfunction status, mean ± SD

Characteristics	GLS < -18% (n = 151)	GLS ≥ -18% (n = 42)	P value
Clinical characteristics
Age (year)	61.11 ± 8.16	58.93 ± 7.76	0.123
Male gender (%)	57.6	54.8	0.741
Diabetes duration (year)	3.68 ± 4.76	4.43 ± 5.47	0.383
BMI (kg/m2)	30.85 ± 5.56	31.35 ± 5.35	0.604
BMI ≥ 30 (%)	50.3	59.5	0.291
WC (cm)	108.56 ± 11.70	111.38 ± 12.02	0.171
SBP (mmHg)	134.99 ± 15.90	138.93 ± 17.46	0.167
DBP (mmHg)	82.03 ± 9.74	84.93 ± 9.75	0.090
Hypertension (%)	88.1	95.2	0.178
Smoking status (%)
Non smokers	40.4	35.7	0.606
Active smokers	19.2	26.2	-
Former smokers	40.4	38.1	-
CKD (%)	6.0	14.3	0.075
Albuminuria (%)	9.3	26.2	0.004
Retinopathy	3.3	7.3	0.372
Biochemistry
HbA1c (%)	6.48 ± 0.99	6.61 ± 1.00	0.479
Total cholesterol (mg/dL)	177.19 ± 42.58	178.26 ± 39.12	0.883
LDL-cholesterol (mg/dL)	99.61 ± 35.13	101.35 ± 31.33	0.777
HDL-cholesterol (mg/dL)	52.25 ± 11.86	49.76 ± 14.93	0.259
Triglycerides (mg/dL)	113.3 (86.0-147.0)	120.2 (86.5-146.8)	0.529
ACR (mg/mmol)	0.95 (0.60-1.40)	1.50 (0.60-3.35)	0.014
eGFR (mL/minute/1.73 m2)	88.53 ± 15.26	87.83 ± 18.67	0.804
NTpro-BNP (ng/L)	44.5 (28.5-82.5)	51.62 (25.0-104.3)	0.127
Uric acid (mg/L)	5.33 ± 1.43	6.04 ± 2.11	0.052
Glucose lowering medication (%)
Metformin	84.8	85.7	0.879
DDP-4 inhibitors	11.3	9.5	0.750
SGLT-2 inhibitors	23.2	26.2	0.685
GLP-1 receptor agonists	26.5	33.3	0.382
Insulin	6.0	11.9	0.997

Data are expressed as mean ± SD, percentage or geometric mean (25%-75%) for log-transformed data. GLS: Global longitudinal strain; BMI: Body mass index; WC: Waist circumference; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; CKD: Chronic kidney disease; HbA1c: Glycated haemoglobin A1c; LDL: Low-density lipoprotein; HDL: High-density lipoprotein; eGFR: Estimated glomerular filtration rate; ACR: Albumin-creatinine ratio; NTpro-BNP: N-terminal pro b-type natriuretic peptide; DDP-4: Dipeptidyl peptidase-4; SGLT-2: Sodium-glucose cotransporter-2; GLP-1: Glucagon-like peptide-1.

Table 3 Echocardiografic parameters of 193 type 2 diabetes subjects stratified by global longitudinal strain-left ventricular systolic dysfunction status, mean ± SD

Characteristics	GLS < -18 (n = 151)	GLS ≥ -18% (n = 42)	P value
Structural parameters
LVMi (mL/m2)	87.94 ± 18.24	89.57 ± 18.10	0.608
IVS (mm)	11.02 ± 1.32	11.07 ± 1.764	0.826
PW (mm)	10.34 ± 1.19	10.43 ± 1.38	0.696
RWT	0.47 ± 0.69	0.46 ± 0.79	0.687
EDV/BSA	48.79 ± 9.56	48.13 ± 12.3	0.715
LVH (%)	17.9	19.0	0.862
Diastolic function
Lateral e’ (cm/seconds)	10.36 ± 2.60	9.72 ± 2.43	0.175
E/e’ average	7.71 ± 2.31	8.25 ± 2.48	0.202
LAVI (mL/m2)	31.30 ± 7.31	30.35 ± 8.999	0.435
Systolic function
EF (%)	61.74 ± 3.51	59.74 ± 4.19	0.002

GLS: Global longitudinal strain; LVMi: Left ventricle mass index; IVS: Interventricular septum; PW: Posterior wall; RWT: Relative wall thickness; EDV: End-diastolic volume; BSA: Body surface area; LVH: Left ventricular hypertrophy; e’: Mitral annulus velocity; E/e’: E-wave/mitral annulus velocity; LAVI: Left atrial volume index; EF: Ejection fraction.

Table 4 Echocardiografic parameters of 193 type 2 diabetes subjects stratified by class of albuminuria, mean ± SD

Characteristics	Normoalbuminuria (n = 168)	Albuminuria (n = 25)	P value
Structural parameters
LVMi (mL/m2)	87.80 ± 17.09	94.36 ± 26.08	0.074
IVS (mm)	11.03 ± 1.42	11.00 ± 1.47	0.915
PW (mm)	10.33 ± 1.18	10.60 ± 1.56	0.302
RWT	0.47 ± 0.07	0.46 ± 0.07	0.623
EDV/BSA	48.90 ± 9.81	46.92 ± 12.47	0.366
LVH (%)	17.3	24.0	0.415
Diastolic function
Lateral e’ (cm/seconds)	10.18 ± 2.42	10.57 ± 3.53	0.504
E/e’ average	7.78 ± 2.30	8.15 ±2.69	0.482
LAVI (mL/m2)	31.20 ± 7.16	30.19 ± 10.79	0.541
Systolic function
EF (%)	61.29 ± 3.76	61.36 ± 3.72	0.932
GLS	-19.88 ± 2.16	-18.29 ± 2.99	0.001

LVMi: Left ventricle mass index; IVS: Interventricular septum; PW: Posterior wall; RWT: Relative wall thickness; EDV: End-diastolic volume; BSA: Body surface area; LVH: Left ventricular hypertrophy; e’: Mitral annulus velocity; E/e’: E-wave/mitral annulus velocity; LAVI: Left atrial volume index; EF: Ejection fraction; GLS: Global longitudinal strain.

Table 5 Linear regression analysis of clinical factors associated with the dependent variable global longitudinal strain

Characteristics	β (95%CI)	P value
WC	0.153 (0.015-0.296)	0.032
SBP	0.181 (0.021-0.404)	0.011
DBP	0.147 (0.013-0.244)	0.043
lnACR	0.250 (0.001-0.027)	< 0.001
Uric Acid	0.203 (0.002-0.040)	0.007
Lateral e’	-0.164 (- 0.322 to 0.007)	0.041

CI: Confidence interval; WC: Waist circumference; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; lnACR: Natural logarithm of albumin-creatinine ratio; e’: Mitral annulus velocity.

Table 6 Odd ratios for global longitudinal strain≥ -18 in the cohort of 193 type 2 diabetes patients

Characteristics	OR (95%CI) model 1	OR (95%CI) model 2	OR (95%CI) model 3
Albuminuria	3.749 (1.343-10.467)	5.185 (1.676-16.040)	6.011 (1.874-19.286)

Model 1: Adjusted for age, sex, diastolic blood pressure, chronic kidney disease; Model 2: Model 1 + ejection fraction, e’ lateral, uric acid; Model 3: Model 2 + treatment (renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, β-blockers); OR: Odds ratio; CI: Confidence interval.