Echocardiographic evaluation of left ventricular diastolic dysfunction in recently diagnosed type 2 diabetes mellitus
Keywords:BMI, Diabetes mellitus, Diastolic dysfunction, HbA1c
Background: Diastolic dysfunction in patients suffering from diabetes mellitus represents an earlier stage in the natural history of cardiomyopathy. This study was done to assess the left ventricular diastolic dysfunction in recently diagnosed (<5yr) Type 2 Diabetes Mellitus by Echocardiography and also to determine association of glycemic status (by HBA1c levels) with left ventricular diastolic dysfunction (LVDD).
Methods: An observational descriptive study involving 100 diabetic patients, taken on first come first serve basis after applying inclusion and exclusion criteria. In all the subjects, other than routine investigations, HbA1c was estimated and echocardiography was done to evaluate LVDD.
Results: Mean value of HbA1c in the study was 8.31+ 1.408 %. 63 out of 100 subjects had LVDD. There was significant positive correlation between HbA1c and LVDD (p value <0.001). As HbA1c increased, severity of LVDD increased. In this study, as BMI increased, HbA1c and LVDD increased & both findings were statistically significant (p value =0.001).
Conclusion: Our study indicates that myocardial damage in patients with diabetes affects diastolic function before systolic function &higher HbA1C level is strongly associated with presence of LVDD. Patients should be advised strict control of diabetes in order to reduce the risk for developing LVDD which is a precursor for more advanced disease.
Keywords: Diabetes mellitus, Diastolic dysfunction, BMI, HbA1c
A.P.I. Textbook of Medicine, 8th Edition. Heart Failure; Upendra Kaul;2012:468-478.
Fagan TC, Sowers J. Type 2 diabetes mellitus: greater cardiovascular risks and greater benefits of therapy. Arch Intern Med. 1999;159:1033-4.
Kazik A, Wilczek K, Poloski L. Management of diastolic heart failure. Cardiol J. 2010;17:558-65.
Sujino T, Kawasaki D, Bonow RO. New insights into diastolic heart Failure. Role of diabetes mellitus. Am J Med. 2005;116(suppl6):34S-45S.
Marwick TH. Diabetic heart disease. Heart. 2006;92:296-300.
Gupta A, Gupta H, Jain H. Echocardiographic study of left ventricular diastolic dysfunction in normotensive asymptomatic type II diabetes mellitus. IOSR-JDMS. 2015;14(7):39-43.
Patil VC, Shah KB, Vasani JD, Shetty P, Patil HV. Diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function. J cardiovascular disease research. 2011 Oct 1;2(4):213-22.
Patil MB, Burji NP. Echocardiographic evaluation of diastolic dysfunction in asymptomatic type 2 diabetes mellitus. J Assoc Physicians India. 2012 May;60(60):23-6.
Poirier P, Bogaty P, Garneau C, Marois L, Dumesnil JG. Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes: importance of maneuvers in echocardiographic screening for preclinical diabetic cardiomyopathy. Diabetes care. 2001 Jan 1;24(1):5-10.
Kumar S, Aneja GK, Trivedi A, Atam V, Singh A, Verma N, et al. Glycosylated Hemoglobin (HbA1c) is a reliable Predictor of left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD) in newly diagnosed type 2 diabetic patients of western Uttar Pradesh. DIABETES. 2014;126(200):6-5.
Patiakas S, Charalampous C. Correlation Between The Glycated Hemoglobin (Hba1c) Level, The Arterial Blood Pressure (AP) And The Body Mass Index (BMI) In Diabetic Patients, And Evaluation Of Its Utility As AC: Pp. 17.170. Journal of Hypertension. 2010 Jun 1;28:e300.
Maiello M, Zito A, Cecere A, Ciccone MM, Palmiero P. Left ventricular diastolic dysfunction in normotensive postmenopausal women with type 2 diabetes mellitus. Cardiology journal. 2017;24(1):51-6.
Ammar KA, Redfield MM, Mahoney DW, Johnson M, Jacobsen SJ, Rodeheffer RJ. Central obesity: association with left ventricular dysfunction and mortality in the community. American heart journal. 2008 Nov 1;156(5):975-81.
Kossaify A, Nicolas N. Impact of overweight and obesity on left ventricular diastolic function and value of tissue Doppler echocardiography. Clinical Medicine Insights: Cardiology. 2013 Jan;7:CMC-S11156.
Aljaroudi W, Halley C, Houghtaling P, Agarwal S, Menon V, Rodriguez L, et al. Impact of body mass index on diastolic function in patients with normal left ventricular ejection fraction. Nutrition & diabetes. 2012 Aug;2(8):e39.