CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 150 AFRICA thicker IVS, wider LVED and a higher LVM, with a lower LV ejection fraction than those with concentric remodelling. The E/A ratio was significantly lower for participants with concentric remodelling compared to those with normal LV geometry, and for those with LVH compared to normal LV geometry. As illustrated in Table 3, as well as in Figs 1 to 6, the correlation between HOMAIR and LVED, IVS, PWT, sum of wall thickness (SWT), LVM indexed to height2.7 (LVMIh), LVM indexed to body surface area (LVMIbsa), RWT and E-wave deceleration was 29.8, 41.6, 42.6, 44.1, 43.7, 44.5, 23.9 and 24.9%, respectively. Multiple linear regression (Table 4) demonstrated that insulin level and HOMAIR explained 46.8% of the increase in IVS (R2 = 0.468) and 30.9% of the increase in DT (R2 = 0.309). HOMAIR alone explained 30.1% of the increase in LVED (R2 = 0.301). Insulin alone explained 46.3% of the increase in PWT (R2 = 0.463) and 29.4% for RWT (R2 = 0.294). Discussion The purpose of this study was to evaluate the association of IR/ hyperinsulinaemia with components of Devereux’s formula and parameters of LV diastolic function. The results suggest that IR and hyperinsulinaemia have different effects on components of Devereux’s formula, depending on whether they act in synergy or in isolation. IR alone appears to increase LVM only by dilation of LVED, while hyperinsulinaemia alone may increase LVM by a trophic effect on the posterior wall. Only their synergistic action seems to Table 2. Biological and ultrasound characteristics of patients according to LV geometry Variables Total (n = 220) Normal (n = 32) CR (n = 99) Concentric LVH (n = 89) p-value normal LVG vs CR p-value normal LVG vs concentric LVH p-value concentric LVH vs CR Glycaemia (mmol/l) 5.8 ± 1.9 5.2 ± 1.2 5.4 ± 1.6 6.4 ± 2.2 0.517 0.004 0.004 TC (mmol/l) 5.5 ± 1.0 5.0 ± 1.0 5.5 ± 1.0 5.5 ± 1.0 0.015 0.017 0.999 LDL-C (mmol/l) 3.7 ± 1.1 3.3 ± 1.1 3.7 ± 1.1 3.9 ± 1.1 0.076 0.009 0.215 Triglycerides (mmol/l) 1.14 ± 0.6 0.91 ± 0.4 1.11 ± 0.6 1.25 ± 0.6 0.081 0.003 0.112 HDL-C (mmol/l) 1.21 ± 0.3 1.27 ± 0.3 1.28 ± 0.4 1.13 ± 0.3 0.897 0.025 0.004 AI 4.8 ± 1.6 4.1 ± 0.9 4.7 ± 1.9 5.2 ± 1.6 0.088 0.004 0.054 HbA1c (%) 6.1 ± 1.3 5.7 ± 1.0 5.9 ± 1.0 6.4 ± 1.6 0.327 0.022 0.010 Creatinine (mmol/l) 84.5 ± 19.0 84.5 ± 18.1 84.3 ± 15.8 84.6 ± 22.5 0.952 0.982 0.915 Uric acid (mmol/l) 367.1 ± 94.6 317.1 ± 78.6 363.6 ± 90.7 388.2 ± 97.9 0.010 0.003 0.075 Insulin (mmol/l) 92.9 ± 41.8 68.2 ± 21.4 73.3 ± 25.8 123.2 ± 43.0 0.314 < 0.001 < 0.001 Calcium (mmol/l) 2.33 ± 0.2 2.32 ± 0.3 2.34 ± 0.2 2.30 ± 0.2 0. 667 0.674 0.173 Ionised calcium (mmol/l) 1.21 ± 0.2 1.24 ± 0.2 1.21 ± 0.1 1.20 ± 0.1 0.462 0.277 0.496 Phosphorus (mmol/l) 1.08 ± 0.2 1.14 ± 0.5 1.08 ± 0.2 1.06 ± 0.2 0.328 0.210 0.495 Hb (mg/dl) 13.4 ± 1.4 13.6 ± 1.6 13.4 ± 1.4 13.3 ± 1.3 0.499 0.295 0.614 HOMAIR 1.79 ± 0.8 1.42 ± 0.8 1.39 ± 0.5 2.37 ± 0.8 0.802 < 0.001 < 0.001 LVED (mm) 44.3 ± 4.6 45.7 ± 2.6 41.9 ± 4.0 46.5 ± 4.4 < 0.001 0.335 < 0.001 IVS (mm) 11.5 ± 1.7 9.0 ± 1.2 11.2 ± 1.3 12.7 ± 1.1 < 0.001 < 0.001 < 0.001 PWT (mm) 11.4 ± 1.6 9.0 ± 0.8 11.2 ± 1.3 12.5 ± 0.9 < 0.001 < 0.001 < 0.001 SWT 22.9 ± 3.1 18.1 ± 1.9 22.3 ± 2.4 25.2 ± 1.6 < 0.001 < 0.001 < 0.001 LVEF 64.6 ± 5.1 63.8 ± 4.4 65.5 ± 4.9 63.7 ± 5.4 0.083 0.925 0.018 LVM (g) 183.0 ± 48.4 139.5 ± 24.6 160.9 ± 34.3 222.8 ± 38.5 0.001 < 0.001 < 0.001 LVMIh (g/m2.7) 44.4 ± 11.1 34.4 ± 5.2 38.4 ± 6.4 54.7 ± 8.4 0.002 < 0.001 < 0.001 LVMIbsa (g/m2) 91.2 ± 20.8 71.9 ± 10.5 81.8 ± 15.1 108.6 ± 15.6 0.008 < 0.001 < 0.001 RWT 0.52 ± 0.1 0.40 ± 0.1 0.54 ± 0.1 0.55 ± 0.07 < 0.001 < 0.001 0.433 E (cm/s) 0.99 ± 0.7 1.31 ± 0.9 1.00 ± 0.5 0.86 ± 0.9 0.015 < 0.001 0.183 E/A ratio 0.99 ± 0.2 1.15 ± 0.1 0.75 ± 0.2 0.71 ± 0.2 < 0.001 < 0.001 0.173 DT (ms) 201.9 ± 40.0 178.1 ± 29.4 197.8 ± 39.2 215.3 ± 39.6 0.011 < 0.001 0.003 Sa (cm/s) 12.4 ± 1.4 12.9 ± 1.2 12.3 ± 1.2 12.4 ± 1.6 0.015 0.109 0.626 LAA (cm2) 15.7 ± 3.3 13.8 ± 1.9 14.9 ± 2.8 17.3 ± 3.5 0.040 < 0.001 < 0.001 sPAP (mmHg) 26.4 ± 2.9 24.5 ± 1.9 26.5 ± 2.7 27.0 ± 3.1 0.002 < 0.001 0.239 Variables are presented as mean ± SD or n (%). CR: concentric remodelling; TC: total cholesterol; LDL-C: low-density lipoprotein cholesterol; HD-C: high-density lipoprotein cholesterol; AI: atherogenic index; HbA1c: glycated haemoglobin; Hb: haemoglobin; HOMAIR: homeostatic model assessment for insulin resistance; LVED: left ventricular end-diastolic diameter; IVS: interventricular septum diameter; PWT: posterior wall thickness; SWT: sum of wall thickness; LVEF: left ventricular ejection fraction; LVM: left ventricular mass; LVMIh: left ventricular mass indexed to height2.7; LVMIbsa: left ventricular mass indexed to body surface area; RWT: relative wall thickness; E: peak E-wave velocity; DT: deceleration time; LAA: left atrial area; sPAP: systolic pulmonary arterial pressure. Table 3. Correlation between HOMAIR, insulinaemia and LV measurments and diastolic function parameters Variables HOMAIR Insulin r p-value r p-value LVED (mm) 0.298 < 0.001 0.273 < 0.001 IVS (mm) 0.416 < 0.001 0.468 < 0.001 PWT (mm) 0.426 < 0.001 0.463 < 0.001 SWT 0.441 < 0.001 0.489 < 0.001 LVMIh (g/m2.7) 0.437 < 0.001 0.448 < 0.001 LVMIbsa (g/m2) 0.445 < 0.001 0.472 < 0.001 RWT 0.239 < 0.001 0.288 < 0.001 DT (ms) 0.249 < 0.001 0.304 < 0.001 LVED: left ventricular end-diastolic diameter; IVS: interventricular septum; PWT: posterior wall thickness; SWT: sum of wall thickness; LVMIh: left ventricular mass indexed to height2.7; LVMbsa: left ventricular mass indexed to body surface area; RWT: relative wall thickness; DT: deceleration time.
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