Left ventricular filling pressure in male patients with type 2 diabetes and normal versus low total testosterone levels.

Background: Heart failure is a common complication of diabetes characterized by an elevation in left ventricular filling pressures (LVF) that often develops in the absence of clinical symptoms. Diastolic dysfunction in the setting of low total testosterone (LTT) occurs through changes in the regulation of peripheral hemodynamics. LTT is highly prevalent among individuals with type 2 diabetes. The aim of this study was to compare LVF in male diabetic patients with no structural heart disease and normal serum testosterone levels vs. those with LTT.

Methods: Type 2 diabetic patients were assessed using tissue Doppler imaging to evaluate LVF and other conventional parameters of diastolic function. The E/e' ratio was used to estimate LVF through the ratio of peak passive trans-mitral left ventricular inflow velocity to the peak passive inflow velocity at the lateral mitral annulus. Patients were assigned to one of two groups based upon their total testosterone levels. Group A consisted of low (< 3.5 ng/mL) testosterone levels and group B consisted of normal (> 3.5 ng/mL) testosterone levels.

Results: A total of 148 male patients were included: group A--47 (32%) patients; group B--101 (68%) patients, respectively. Mean age was 58 ± 5.8 years and mean time of diabetes evolution was 7 ± 3.1 years. There were no significant differences between the groups regarding age, duration of diabetes evolution, hypertension, weight, heart rate, body mass index, and echocardiographic parameters. The E/e' ratio for group A was 8.05 ± 1.9 vs. 6.1 ± 1.7 for group B (p < 0.0001). The E/A ratio was 0.94 ± 0.10 vs. 1.19 ± 0.12 (p = 0.01), deceleration time 242 ± 7.4 ms vs. 205 ± 9 ms (p = 0.026) and systolic pulmonary artery pressure 27 ± ± 2.2 mm Hg vs. 22 ± 1.7 mm Hg (p = 0.11).

Conclusions: Patients with type 2 diabetes and LTT have a higher E/e' ratio demonstrating a pre-clinical increase in LVF when compared to similar patients with normal testosterone levels. This finding is independent of time of diabetes evolution, hypertension and other echocardiographic parameters.