Published: 2019-09-23

Detection and evaluation of left ventricular diastolic dysfunction in asymptomatic type 2 diabetic patients by conventional and tissue doppler imaging

Ekanthalingam S., Sharavanan T. K. V., Kannan I., Premalatha E., Prasanna K. B.


Background: Diabetic cardiomyopathy is characterised predominantly by diastolic dysfunction. While the traditional echocardiography provides only semiquantitative assessment of diastolic dysfunction, tissue Doppler imaging proved to be an effective technique for the quantification of subclinical diastolic dysfunction.

Methods: The current cross-sectional study was conducted in out-patient department of General Medicine, Tagore Medical College and Hospital for a period of 6 months. The study population comprised of 100 patients with type 2 diabetes mellitus including 39 male and 61 females. Echocardiography (using Siemens – Acuson NX3 Elite - system with TDI technology) was performed to all subjects in the left lateral position and 2D, M- mode, Doppler techniques were used. The early E wave corresponding to early ventricular filling and A wave which reflect a trial contraction were typically measured to assess the transmitral flow pattern. Systolic S' (Sa), early diastolic E (Ea) and the late diastolic velocities A' (Aa) were measured by tissue Doppler imaging.

Results: The E/A ratio ranged from 0.5 to 2 and E/Ea ratio ranged from 1.59 to 14.67. Around 23 patients and 54 patients were abnormal by E/A and E/Ea ratios respectively. Around 29 patients showed grade II diastolic dysfunction by tissue Doppler imaging

Conclusions: Prompt diagnosis of diastolic dysfunction help us to identify high risk patients who are likely to be benefitted by early therapeutic intervention. Tissue Doppler imaging may be a better tool in the identification of diastolic dysfunction especially grade II in comparison with the conventional echocardiography.


Diastolic dysfunction, Pseudo-normal pattern, Tissue Doppler imaging

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Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. The Lancet. 2010 Jun 26;375(9733):2215-22.

Gu K, Cowie CC, Harris MI. Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971-1993. Diabetes Care. 1998;21(7):1138-45.

Bertoni AG, Hundley WG, Massing MW, Bonds DE, Burke GL, Goff DCJr. Heart failure prevalence, incidence, and mortality in the elderly with diabetes. Diabetes Care. 1998 Jul 1;21(7):1138-45.

Shehadeh A, Regan TJ. Cardiac consequences of diabetes mellitus. Clin Cardiol. 1995;18:301-5.

Asbun J, Villarreal FJ. The pathogenesis of myocardial fibrosis in the setting of diabetic cardiomyopathy. J Am Coll Cardiol. 2006;47:693-700.

Asbun J, Villarreal FJ. The pathogenesis of myocardial fibrosis in the setting of diabetic cardiomyopathy. J Am Coll Cardiol. 2006;47:693-700.

Ashrafian H, Frenneaux MP, Opie LH. Metabolic mechanisms in heart failure. Circulation. 2007; 116:434-48.

From AM, Scott CG, Chen HH. The development of heart failure in patients with diabetes mellitus and pre-clinical diastolic dysfunction a population-based study. J Am Coll Cardiol. 2010;55:300-5.

Sutherland GR, Stewart MJ, Groundstroem KW, Moran CM, Fleming A, Guell-Peris FJ, et al. Color Doppler myocardial imaging: a new technique for the assessment of myocardial function. J the Am Society of Echocardiogr. 1994 Sep 1;7(5):441-58.

Donovan CL, Armstrong WF, Bach DS. Quantitative Doppler tissue imaging of the left ventricular myocardium: validation in normal subjects. Am Heart J. 1995;130(1):100-4.

Rodriguez L, Garcia M, Ares M, Griffin BP, Nakatani S, Thomas JD. Assessment of mitral annular dynamics during diastole by Doppler tissue imaging: comparison with mitral Doppler inflow in subjects without heart disease and in patients with left ventricular hypertrophy. Am Heart J. 1996;131(5):982-7.

Dokainish H. Tissue Doppler imaging in the evaluation of left ventricular diastolic function. Curr Opin Cardiol. 2004;19(5):437-41.

Khouri SJ, Maly GT, Suh DD, Walsh TE. A practical approach to the echocardiographic evaluation of diastolic function. J. Am. Soc Echocardiogr. 2004;17(3):290-7.

Bonito PD, Cuomo S, Moio N, Sibilio G, Sabatini D, Quattrin S, et al. Diastolic dysfunction in patients with non‐insulin‐dependent diabetes mellitus of short duration. Diabetic medicine. 1996 Apr;13(4):321-4.

Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr. 1989 Sep 1;2(5):358-67.

Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol. 1974;34(1):29-34.

Brownlee M. Advanced protein glycosylation in diabetes and aging. Annu Rev Med.1995;46:223-34.

Ojji D, Parsonage W, Dooris M, Adebiyi A, Oladapo O, Adeleye J, et al. Left ventricular diastolic function in normotensive type-2 diabetic subjects. J National Medical Association. 2008 Sep 1;100(9):1066-72.

Boyer JK, Thanigaraj S, Schechtman KB, Pérez JE. Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Am J Cardiol. 2004 Apr 1;93(7):870-5.

Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation. 2000 Oct 10;102(15):1788-94.