Left ventricular mass reduction in type 1 diabetic patients with nephropathy.

Left ventricular hypertrophy regression was postulated more likely to occur in diabetic patients when renal function was preserved. Seventeen type 1 diabetic patients followed for 12 months while receiving protocol-driven glycemic and blood pressure control had baseline and 12-month echocardiography. Despite identical treatment resulting in similar blood pressures, patients with better renal function (below the group mean, serum creatinine < or =1.7 mg/dL) demonstrated reduction in left ventricular mass and septal thickness as well as increase in left ventricular fractional fiber shortening not observed in those with worse renal function (above the group mean, serum creatinine >1.7 mg/dL). This latter group also did not experience the improvement in glycemic control observed in those with better renal function. Regression of left ventricular mass and functional improvement can be accomplished with improved glycemic control. In the presence of renal dysfunction, however, efforts to control glycemia and cardiac work are suboptimal. Aggressive glycemic and blood pressure targets to reduce cardiovascular morbidity in this high-risk population should be studied.