ECHOCARDIOGRAPHIC EVALUATION OF LV DIASTOLIC DYSFUNCTION IN ASYMPTOMATIC TYPE 2 DIABETES MELLITUS PATIENTS WITH NORMAL LVEF.

Ramchandra I. Nalawade, Vrushali R. Nalawade

Abstract


Introduction: Diabetes mellitus is one of the most common disease in the world and is acquiring epidemic proportions. India is the Diabetic capital
of the world. Indians are genetically more susceptible to diabetes compared to other races. Cardiovascular complications are known to be the main
cause of morbidity and death in diabetic patients. Left ventricular diastolic dysfunction in diabetic patients is very common and represents an early
stage of heart failure without any clinical manifestations before systolic dysfunction. The incidence of heart failure in diabetic subjects is high even
in the absence of hypertension and coronary artery disease. In the view of these above facts the present study was done to assess the diastolic
dysfunction in asymptomatic diabetic patients.
Aims: The aim of this study was to detect the incidence of LV diastolic dysfunction in asymptomatic Diabetic subjects and its relation to
various parameters
Settings and Design: This was an observational & descriptive study conducted at the teaching hospital during a one year period.
Materials and Methods: This study included 165 asymptomatic patients with type 2 diabetes mellitus, without evidence of cardiovascular
involvement and blood pressure less than 130/80 mmHg. LVDD was evaluated by Doppler Echocardiography, which included PWD MV - E/A
ratio, DT, IVRT, Average E/e' ratio, TDI MV septal diastolic e' Velocity & Indexed left atrial volume . LVDD was assessed in relation with age,
sex, duration of diabetes, Fasting, PP BSL level, HbA1c level, obesity, Lipid profile, urine microalbuminurea & LV mass.
Results: Results showed that out of 165 studied patients LV diastolic dysfunction was present in 122 (73.9 %) patients. Among Males & females
patients diastolic dysfunction was present in 84 cases (86.6%) & 65cases (95.6%) respectively with more prevalence in females. Increased
prevalence of LV Diastolic dysfunction was associated with increase in age, duration of diabetes, uncontrolled diabetes as assessed by HbA1c
levels, Obesity, dyslipidemia, Microalbuminurea, increased LA Volume & LV mass.
Conclusions: Present study reveals high incidence of diastolic dysfunction in asymptomatic Diabetic subjects and this finding was correlated with
the age, sex, duration of diabetes, HbA1c Levels, obesity, Lipid profile, urinary microalbuminurea, and LA Size & LV mass. The findings in our
Study indicate that early myocardial damage in patients with diabetes mellitus affects left ventricular diastolic function before systolic function.
Combination of Conventional Doppler & Tissue Doppler echocardiography parameters is a simple, noninvasive, cheap, easily available and a
valuable tool in diagnosing diastolic dysfunction. In diabetics before they develop cardiac symptoms, echocardiography should be done routinely
on every diabetic patients to assess the cardiac function.


Keywords


Left ventricular diastolic dysfunction, Diabetes mellitus, Echocardiography.

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