Prevalence of left ventricular diastolic dysfunction among patients with asymptomatic diabetes mellitus type 2
Keywords:2 D echocardiogram, Cardiomyopathy, Diabetes, Diastolic dysfunction, HbA1c, Insulin resistance
Background: Diastolic heart failure occurs due to impaired myocardial relaxation and compliance. Of late, it has been suggested that the changes in the diastolic function occurs before the onset of diabetes, and present in the prediabetic patients. It is also said to be associated with insulin resistance.
Methods: This observational study was performed on 50 diabetic patients, with asymptomatic type 2 diabetes. who came in for 2 D echocardiogram with suspected diastolic dysfunction.
Results: The mean age among the 50 patients in the study was 54.1±10.99 years and in controls it was 49.56±10.63 years. The fasting sugar among the patients was 179.43±41.57 mg/dl and the post prandial was 236.72±76.24, and it was in the normal range in the controls. The HbA1c was 9.93±1.2 among the patients and 6.09 ± 0.34 in the controls. In the patients, the E/A ratio was 0.83±0.09 compared to 1.22±0.31 of the controls, which was highly significant as the E/e ratio which was 15.1±3.4 and 7.3±0.08 respectively.
Conclusions: There was a higher prevalence of diastolic dysfunction among the patients with diabetes in our study. There was no relation of age or gender among the diabetic and the controls, while a strong association and indicators seem to be FBS, PLBS and HbA1c.
Nichols GA, Hillier TA, Erbey JR, Brown JB. Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors. Diabetes care. 2001;24(9):1614-9.
Young LH, Chyun DA. Heart disease in patients with diabetes. In: Ellenberg & Rifkin’s Diabetes Mellitus. Porte D Jr, Baron A, Sherwin R, Eds. New York, McGraw-Hill. 2002:823-44.
Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation. 2000;101(17):2118-21.
Piccini JP, Klein L, Gheorghiade M, Bonow RO. New insights into diastolic heart failure: role of diabetes mellitus. Am J Med. 2004;116(5):S64-75.
Boyer JK, Thanigaraj S, Schechtman KB, Perez JE. Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Am J Cardiol. 2004;93(7):870-5.
Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003;289(2):194-202.
Zabalgoitia M, Ismaeil MF, Anderson L, Maklady FA. Prevalence of diastolic dysfunction in normotensive, asymptomatic patients with well-controlled type 2 diabetes mellitus. Am J Cardiol. 2001;87(3):320-3.
Fang ZY, Prins JB, Marwick TH. Diabetic cardiomyopathy: evidence, mechanisms, and therapeutic implication. Endocr Rev. 2004;25(4): 543-67.
From AM, Scott CG, Chen HH. Changes in diastolic dysfunction in diabetes mellitus over time. Am J Cardiol. 2009;103(10):1463-6.
Factor SM, Minase T, Sonnenblick EH. Clinical and morphological features of human hypertensive-diabetic cardiomyopathy. Am Heart J. 1980;99(4):446-58.
Tian R, Nascimben L, Ingwall JS, Lorell BH. Failure to maintain a low ADP concentration impairs diastolic function in hypertrophied rat hearts. Circulation. 1997;96(4):1313-9.
Suresh G, Alva R, Prakash PS, Saya RP. Prevalence of asymptomatic left ventricular diastolic dysfunction in type 2 diabetic patients and healthy controls: A comparative study. Arch Med Health Sci. 2017;5(1):30-3.
Jain K, Palange AA, LalKakrani A, Dhanorkar AS. Left ventricular diastolic dysfunction in asymptomatic type 2 diabetes mellitus patients. Int J Res Med Sci. 2018;6(1):240-6.
Sharavanan TKV, Prasanna KB, Ekanthalingam S, Sundaram A, Premalatha E, Arumugam B. A study on the prevalence of diastolic dysfunction in type 2 diabetes mellitus in a tertiary care hospital. IAIM. 2016;3(7):216-21.
Russo C, Jin Z, Homma S, Rundek T, Elkind MS, Sacco RL, et al. Effect of obesity and overweight on left ventricular diastolic function: a communitybased study in an elderly cohort. J Am Coll Cardiol. 2011;57(12):1368-74.
Raev DC. Which LV function is impaired earlier in the evolution of diabetic cardiomyopathy? An echocardiographic study of young type I diabetic patients. Diabetes Care. 1994;17(7):633-9.
Patil VC, Patil HV, Shah KB, Vasani JD, Shetty P. Diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function. J Cardiovasc Dis Res. 2011;2(4):213-22.
Ashraf SM, Basir F. Association of hypertension and diastolic dysfunction with type 2 diabetes mellitus. Pak J Medic Sci. 2007;23(3):344-8.
Patil MB, Burji NP: Echocardiographic evaluation of diastolic dysfunction in asymptomatic type 2 diabetes mellitus. J Assoc Physic Ind. 2012;60(60):23-6.