Diastolic Dysfunction In Asymptomatic Type 2 Diabetes Mellitus Evaluated By Echocardiography
Diastolic Dysfunction In Asymptomatic Type 2 Diabetes Mellitus Evaluated By Echocardiography
Keywords:
Type 2 diabetes mellitus, LV diastolic dysfunction, EchocardiographyAbstract
Introduction: As per the latest edition of International Diabetes Federation (IDF) Diabetes Atlas, diabetes mellitus now affects almost 371 million people worldwide, and majorities (90%-95%) have type 2 DM, which is measured metabolic cum vascular disease. There is marked increase in incidence of congestive heart failure, coronary artery disease in diabetic patients. Despite similar left ventricular systolic dysfunction, patients with diabetes have more pronounced heart failure symptoms and adverse prognosis compared with non-diabetic; one putative explanation for these discrepancies is LVDD in DM. The diastolic abnormalities are present in diabetic patients without overt diabetic complications of cardiovascular system, reinforcing the importance of early examination of ventricular function. Methods: This was a simple randomized study, conducted from August 2012 to October 2014. 50 patients with type 2 DM who had no symptoms of cardiovascular disease with normal BP and normal ECG were enrolled. Informed consent was obtained from the patients and they underwent a thorough physical examination, supported by laboratory investigations. A Doppler 2D echo was done in each patient and a calculation of LV ejection fraction, LA dimension; E velocity, A velocity and E/A ratio, IVRT and DT of E were done. Results: Our study consisted of 50 patients with type 2 DM, 27(54%) were males and 23 (46%) females. Majority of patients were in the age group of 50–70 years. Diastolic dysfunction was present in 26 (52%) patients out of whom 16 were males and 12 females. There was a linear increase in prevalence of diastolic dysfunction with increasing age, increased duration of diabetes mellitus and increasing HbA1c levels. Moreover statistically significant are Ejection Fraction, E/A Ratio, IVRT (msec), DT of E such as echocardiographic measurement with different studies. Conclusion: LV diastolic dysfunction is an early manifestation of diabetic cardiomyopathy. Its prevalence correlates with duration of diabetes, HbA1c values. LVDD contributes significantly to morbidity of CHF in diabetic patients. LVDD may be the 1st stage of Diabetic cardiomyopathy and should be screened for LVDD.[Satyam P NJIRM 2017; 8(6):66-70]
References
2. Wild S, Roglic G, Green A, Sicree R, King H (2004). "Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030". Diabetes Care 27 (5): 1047–53. 3. Gale, Jason (November 7, 2010). "India’s Diabetes Epidemic Cuts Down Millions Who Escape Poverty". Bloomberg.
4. Rubler S, Deluges J, Yuceoglu YZ, Kumar T, Bran wood AW, Grishman A. New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 1972; 30:595 -602
5. Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 1974; 34:29-34.
6. Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000;342:145–153.
7. Shindler DM, Kostis JB, Yusus S, Quinones MA, Pitt B, Stewart D, et al, Diabetes mellitus, a predictor of morbidity and mortality in the Studies of Left Ventricular Dysfunction (SOLVD) Trials and Registry. Am J Cardiol 1996;77:1017-20.
8. Cosson S, Kevorkian JP. Left ventricular diastolic dysfunction: a nearly sign of diabetic cardiomyopathy. Diabetes Metab 2003;29:455-466.
9. Zarich SW, Nesto RW. Diabetic cardiomyopathy. Am Heart J2001;35:166-8.
10. Sujino T, Kawasaki d, Bonow RO, New insights into diastolic heart failure. Role of diabetes mellitus. Am J Med 2005;116(suppl6):34S-45S.
11. Vanninen E, Pitale SU. LV Function and dimensions in newly diagnosed non-insulin-dependent mellitus. Am J Cardiol1992;70:371-8.
12. Seneviratne BI. Diabetic cardiomyopathy: the preclinical phase. BMJ, 1977, 1, 1444-6.
13. Regan TJ, Lyons MM, Ahmed SS, et al. Evidence for cardiomyopathy in familial diabetes mellitus. J Clin Invest, 1977, 60, 884-99.
14. Paul Poirier, Pete Bogaty, Caroline Garneau, Marois L, Dumernoil JG, Martin M. et al. Diastolic Dysfunction With Well – controlled Type 2 Diabetes. Diabetes Carer 2004;46:166 -170.
15. Ledet T. Histological and histochemical changes in the coronary arteries of old diabetic patients. Diabetologia, 1968, 4, 268-72.
16. Fisher VW, Barner HB, Leskiw L. Capillary basal laminar thickness in diabetic human myocardium. Diabetes, 1979, 28, 713-9.
17. Factor SM, Okun EM, Minase T. Capillary microaneurysms in the human diabetic heart.NEnglJMed, 1980, 302, 384-8.
18. Zoneraich S, Silverman G, Zoneraich O. Primary myocardial disease, diabetes mellitus, and small vessel disease. Am Heart J, 1980, 100, 754-5.
19. Nunoda S, Genda A, Sugihara N, Nakayama A, Mizuno S, Takeda R. Quantitative approach to the histopathology of the biopsied right ventricular myocardium in patients with diabetes mellitus. Heart Vessels, 1985, 1, 43-7.
20. Vishwanath V, Frank KE, Elmets CA, Dauchot PJ, Monnier VM. Glycation of skin collagen in type I diabetes mellitus. Correlation with long-term complications. Diabetes, 1986, 35, 916-21.
21. Faden G, Faganello G et al, The increasing detection of asymptomatic left ventricular dysfunction in patients with type 2 diabetes mellitus without overt cardiac disease: Data from the SHORTWAVE study. Diabetes Res ClinPract. 2013 Sep;101(3):309-16.
22. Markuszewski, Grycewiczetal.Glycosylated hemoglobin and left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus. PubMed. 2006 Jul;21(121):8-11.
23. Patil C et al. Diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function. J Cardiovasc Dis Res. 2011 Oct-Dec; 2(4): 213–222
24. Abdul Khaliq M. Left ventricular systolic and diastolic functional abnormalities in asymptomatic patients with non-insulin-dependent diabetes mellitus. Journal of the American Society of Echocardiography. 2001; 14(9):885-891.
25. John K Boyer. Prevalence of ventricular diastolic dysfunction in asymptomatic normotensive patients with diabetes mellitus. American Journal of Cardiology 2004 Apr 1; 93:870-875.
