J Cardiovasc Ultrasound.  2009 Dec;17(4):127-134. 10.4250/jcu.2009.17.4.127.

Comparison of Left Ventricular Hypertrophy, Fibrosis and Dysfunction According to Various Disease Mechanisms such as Hypertension, Diabetes Mellitus and Chronic Renal Failure

• Koh YS
• Jung HO
• Park MW
• Baek JY
• Yoon SG
• Kim PJ
• Ihm SH
• Chang K
• Oh YS
• Youn HJ
• Baek SH
• Chung WS
• Seung KB
• Kim JH

• KMID: 1473715
• DOI: http://doi.org/10.4250/jcu.2009.17.4.127

Abstract

BACKGROUND
Left ventricular hypertrophy (LVH) has been known as an important predictor of prognosis of cardiovascular disease. Carboxy-terminal propeptide of procollagen type I (PIP) is related with myocardial fibrosis. We sought to analyze the differences in the characteristics of LVH, myocardial fibrosis, and LV functions among hypertension (HBP), diabetes mellitus (DM) and chronic renal failure (CRF). METHODS: We enrolled consecutive patients with LVH. Patients were grouped as HBP (n=50), DM (n=41), CRF (n=31). Age and sex-matched normal control was also enrolled (n=32). Echocardiography and blood sampling for serum PIP level measuring was performedin all participants. RESULTS: There were no differences in baseline characteristics except systolic blood pressure among four groups. In three patients groups, their LV mass indices were significantly increased than control. Serum PIP level in CRF was much higher than others (CRF 1505.5 vs. HBP 868.7 vs. DM 687.5 vs. control 826.4, p<0.0001). LV diastolic and systolic function evaluated by E', E/E, S' and midwall fractional shortening was significantly decreased in three patients groups. However, LAVi was significantly elevated and LV ejection fraction was significantly decreased in CRF compared to others. In correlation analysis, indices of diastolic function were weakly, but statistically correlated with PIP (E': r=0.234, p=0.006; LAVi: r=0.231, p=0.006). CONCLUSION: In CRF, LV function was more deteriorated and serum PIP was more elevated when compared to HBP or DM. Therefore, myocardial fibrosis may play an important role to LV dysfunction as well as LV hypertrophy in CRF in some degree.

Keyword

Left ventricular hypertrophy; Carboxy-terminal propeptide of procollagen type I; Fibrosis

MeSH Terms

Blood Pressure
Cardiovascular Diseases
Collagen Type I
Diabetes Mellitus
Echocardiography
Fibrosis
Humans
Hypertension
Hypertrophy
Hypertrophy, Left Ventricular
Kidney Failure, Chronic
Prognosis
Collagen Type I

Figure

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  Fig. 1 Left ventricular mass index (LVMi) by M-mode among four groups. HBP: hypertension, DM: diabetes, CRF: chronic renal failure.

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  Fig. 2 Indices of systolic function among four group. A: Left ventricular ejection fraction (LVEF) among four groups: in CRF groups, LVEF was statistically decreased. B: Fractional shortening midwall (FSmidwall) among four groups: in HBP, DM and CRF group, FSmidwall was significantly decreased. C: S' among four groups: in HBP, DM and CRF group, S' was significantly decreased. CRF: chronic renal failure, HBP: hypertension, DM: diabetes.

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  Fig. 3 Indices of diastolic function among four group. A: Left atiral volume index (LAVi) among four groups: in CRF group, LAVi was significantly increased. B: E' among four groups: in HBP, DM and CRF group, E' was significantly decreased. C: E/E' among four groups: in HBP, DM and CRF group, E/E' was significantly increased. CRF: chronic renal failure, HBP: hypertension, DM: diabetes.

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  Fig. 4 A: Serum level of Carboxy-terminal propeptide of procollagen type I (PIP) among four groups: in CRF group, serum PIP level was significantly higher than other three groups. B: Serum level of PIP between patients with LVH and normal group. HBP: hypertension, DM: diabetes, CRF: chronic renal failure.

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  Fig. 5 Correlation between Serum Carboxy-terminal propeptide of procollagen type I (PIP) level and index of systolic function. A: Correlation between serum PIP level and LVEF. B: Correlation between serum PIP level and S'.

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  Fig. 6 Correlation between serum Carboxy-terminal propeptide of procollagen type I (PIP) level and index of diastolic function. A: Correlation between serum PIP level and LAVi. B: Correlation between serum PIP level and E'. C: Correlation between serum PIP level and E/E'.

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