Assessment of Diastolic Dysfunction in Type 2 Diabetic Patients Without Known Heart Disease

Résumé

Background:

Type 2 diabetes mellitus (T2DM) is a leading cause and risk factor for the emergence of sub clinical cardiac dysfunction which, if unchecked, evolves to more severe heart failure. Diastolic dysfunction is an early, silent form of diabetic cardiomyopathy, but its prevalence and predictors in asymptomatic patients are not well studied, especially in South Asians.

Objective:

To determine the frequency of diastolic dysfunction and its echocardiographic features in asymptomatic type 2 diabetic patients without known heart disease, and to identify significant clinical predictors.

Methods:

It was a cross-sectional study in which 120 asymptomatic T2DM patients who presented to the outpatient clinic in Sahiwal, Pakistan were included. Patients with a previous history of cardiovascular conditions, hypertension, or major co-morbidities were not eligible. Participants all received full transthoracic echocardiography for assessing the diastolic function according to E/A ratio, E/e’ ration, and left atrial volume index (LAVI). At least 2 of these values were diagnostic for diastolic dysfunction. Clinical and metabolic parameters, such as age, gender, diabetes duration, BMI, and HbA1c, were evaluated for correlation with diastolic dysfunction.

Results:

Diastolic dysfunction was found in 44.2% of the patients. Low E/A (14), and enlarged LAVI (>34 mL/m²) were present in 40.8%, 30.0% and 40.0% of cases, respectively. Longer known duration of diabetes (OR 1.21, p<0.001), older age (OR 1.05, p=0.018), and higher HbA1c (OR 1.84, p=0.007) independently predicted diastolic dysfunction in multivariate analysis. Gender and BMI were not significant predictors.

Conclusion:

High prevalence of subclinical diastolic dysfunction in asymptomatic type 2 diabetic patients with and without a heart disease known. Systematic screening of a specific population at high risk (long diabetes duration, older age, higher glycemic levels) might help to identify people with very early changes in the left ventricle and provide early intervention to prevent HF in diabetes to become a large public health target.