Details
Category: Volume 06 Issue 01 January 2018
Hits: 1412

Title: To Study the Diastolic Dysfunction by Echocardiography in young  (<40 years) Type -2 Diabetics

Authors: Dr Janki Punekar, Dr Amit Anurag Singh, Dr Vipin Das P.S.

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i1.98

Abstract

Introduction: Diabetes Mellitus is a disease with multisystem complications. Heart failure is 2-5 times more common in diabetic patients than in non-diabetic population. Left ventricular diastolic dysfunction (LVDD) represents the first stage of diabetic cardiomyopathy preceding systolic dysfunction of the heart. So it is important to examine the ventricular function in individuals with diabetes mellitus. The detection of LVDD has prognostic importance as early intervention can prevent development of systolic dysfunction and heart failure.

Aims and Objectives: To study the prevalence of diastolic dysfunction in young (<40 years) Type - 2 diabetic patients and to correlate the severity of LVDD with duration of diabetes and glycemic control (HbA1C).

Materials & Methods: This  study was carried out in department of medicine NSCB medical college and hospital ,Jabalpur (M. P) and included 50 cases and 50 controls

Results: There is a significant correlation between duration of diabetes and presence of LVDD (Chi square=13.19 and p=0.01).But there is no significant correlation between duration of diabetes and grade of LVDD(Chi square=0.64 and p=0.424). There is significant correlation between HbA1c and presence of LVDD (Chi square=14.14 and p=0.007). But there is no significant correlation between HbA1c and grade of LVDD (Chi square=0.830 and p=0.660)

Conclusion: The prevalence of LVDD in Young (<40 years) Type 2 Diabetics is 32%.As the duration of diabetes increases, there is an increase in the prevalence of LVDD (Chi square=13.19 and p=0.01). There is also a higher prevalence of LVDD in those who have higher HbA1c (Chi square=14.14 and p=0.007).It is suggested that all patients of Diabetes Mellitus should be routinely subjected to 2-D color Doppler echocardiographic assessment of cardiac functions. This has important therapeutic implications as early intervention can prevent development of systolic dysfunction and heart failure.

References

  1. Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414:782-787.
  2. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res ClinPract. 2010;87:4-14
  3. Rubler S, Deluges J, Yuceoglu YZ, Kumar T, Bran wood AW, Grishman A. New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 1972;30:595 -602.
  4. Van Heerebeek L, Hamdani N, Handoko ML, Falcao-Pires I,Musters RJ, Kupreishvili K.et al.Diastoliv stiffness of the failing diabetic heart:Importance of fibrosis, advanced glycation end products, and myocyte resting tension. Circulation 2008:117:43-51
  5. From AM,Scott CG,Chen HH. Changes in diastolic dysfunction in diabetes mellitus over time.Am J Cardiol 2009;103:1463-6
  6. Oh JK.Seward JB,Tajik AJ. Assessment of diastolic dysfunction and diastolic heart failure. In Oh JK,editor.The Echo Manual . 34thNew Delhi:wolters Kluwer: 2006.p.120-41
  7. Zarich SW, Nesto RW: Diabetic Cardiomyopathy. American Heart Journal 118: 1000-1012, 1989.
  8. Cosson S, Kevorkian JP. Left ventricular diastolic dysfunction: an early sign of diabetic cardiomyopathy. Diabetes Metab 2003; 29:455- 66.
  9. Patil MB, Burji NP: Echocardiographic evaluation of diastolic dysfunction in asymptomatic type 2 diabetes mellitus. Journal of the Association of Physicians of India, 2012 May, 60: 23-6.
  10. Sahn DJ, Demaria A, Kisslo J et al : Recommendations regarding quantitation in M mode echocardiography : results of a survey of echocardiographic measure-ments. Circulation, 1978, 58: 1072-1083.
  11. American Diabetes Association: Standards of Medical Care in Diabetes 2016; Classification and Diagnosis of Diabetes; Diabetes Care 2016;39(Suppl. 1):S13–S22 | DOI: 10.2337/dc16-S005.
  12. Diastolic dysfunction in young asymptomatic diabetic patients (N senthil, K vengadakrishnan, sumanth simha vankineni, sujatha.S) Int J Sci Stud 2015;3(7):226-229
  13. Ashraf SM, Basir F: Association of hypertension and diastolic dysfunction with type 2 diabetes mellitus. Pakistan Journal of Medical Sciences, 2007, 23: 344–8.
  14. Study on diastolic dysfunction in newly diagnosed Type 2 diabetes mellitus and its correlation with glycosylated Haemog-lobin (Abhay kumar chaudhari, Girish kumar aneja, Shubhra shukla, syed mohd razi)J Clin Diagn Res;2015:9(8):OC20-OC22
  15. A study of cardiac functions in type 2 diabetic patients (Panda p,Mohapatra D,Panda SK,Mishra T,Priyadarsini N,Behera M)Inj J Med Res Rev 2016:4(7)1221-1227
  16. Fiorina P, La Rocca E, Astorri E. Rversal of LV diastolic dysfunctionafter kidney- pancreas transplantation in type 1 diabetic uraemic patients. Diabetes Care 2000;23:1804-10
  17. Hiramatsu K, Ohara N, Shigematsu S, Aizawa T, Ishihara F, Niwa A, et al. LV filling abnormalities in non –insulin-dependent diabetesmellitus and improvement by a short –term glycemic control. Am J Cardiol 1992;70:1185-9.
  18. Beljic T, Miric M, Bergman C, Villringer A, Bories J Oztekin N,et al. Improved metabolic control does not reverse LV fillingabnormalities in newly diagnosed noninsulin –dependent diabetespatients. Act Diabetol 1994 ;31:147-50.
  19. Gough SC, Smylie J Barker M, Berkin KE, Rice PJ Grant PJ, Et al.Diastolic dysfunction is not related to changes in glycemic controlover 6 months in type 2 (non- insulin- dependent) diabetes mellitus:a cross sectional study. Acta Diabetol 1995;32:110-5.

Corresponding Author

Dr Vipin Das P.S.

RMO Medicine, N.S.C.B. Medical College and Hospital, Jabalpur (M.P.)