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Category: Volume 07 Issue 07 July 2019
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Title: LV Diastolic Dysfunction: An Earliest Marker of Diabetic Cardiomyopathy

Authors: Dr Nitin Agarwal, Tarkeshwar Kumar, Seema Seth, Darshan Mehra

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.50

Abstract

Introduction: Diabetes mellitus (DM) has emerged as a modern epidemic and is at raising trend globally and will continue to be in future. Cardiovascular complications are major cause of death in patients with type II DM. Prior to the development of symptomatic diabetic cardiomyopathy, subclinical left ventricular diastolic dysfunction appears which can be detected by 2d-Echo, thus aiding clinician for taking early intervention  .

Objective: To study the diastolic function of heart in  normotensive asymptomatic  Type 2 diabetes mellitus (T2DM) patients  and  its correlation with duration of diabetes ,age and glycosylated haemoglobin (HbA1c).

Material and Method: Prospective observational study was undertaken in Rohilkhand Medical College and Hospital, Bareilly including 50 normotensive diabetic patients admitted in the medical wards from 1st Jan 2018 to 31st Dec 2018. Detailed clinical examination was done; routine investigations including HbA1c, Blood sugar (fasting and post prandial) and 2D-ECHO were done. Data was collected, computated and analyzed statistically.

Results: Left ventricular diastolic dysfunction was present in 27 cases i.e 54%. Diastolic dysfunction was significantly associated with uncontrolled diabetes as assessed by HbA1c levels. Mean duration of diabetes was 8.07±7.77 years. In our study most of the subjects were having diabetes for 6-10 years and were between 56.38±12.2 years of age group. The mean E/A ratio was 0.73±0.13 among the patient who had diastolic dysfunction (E/A <1 considered as diastolic dysfunction) and 1.36±0.20 without diastolic dysfunction statistically it was significant.

Conclusion: This study concludes that myocardial damage in patients with diabetes affects diastolic function before systolic function. E/A ratio is significantly altered in diabetic patients with diastolic dysfunction.  Duration of disease, glycemic levels and the type of treatments significantly alter the diastolic function in diabetic patients. 2-D ECHO is a simple non invasive and reproducible valuable  tool in diagnosing diastolic dysfunction which helps in early detection of myocardial injury before actual clinical manifestation appears indicating early intervention/treatment  and can retard the progression of further myocardial injury.

References

  1. World Health Organisation. Addressing health inequalities in Indonesia, 2017. Available at http://www.who.int
  2. Chandalia M, Abate N, Garg A, Stray-Gundersen J, Grundy SM. Relationship between generalized and upper body obesity to insulin resistance in Asian Indian men. J Clin Endo Metab. 1999;84:2329-35.
  3. Misra A, Vikram NK. Insulin resistance syndrome (metabolic syndrome) and Asian Indians. Current Science. 2002:1483-96.
  4. Mohan V, Sharp PS, Cloke HR, Burrin JM, Schumer B, Kohner EM. Serum immunoreactive insulin responses to a glucose load in Asian Indian and European type 2 (non-insulin-dependent) diabetic patients and control subjects. Diabetologia. 1986;29(4):235-7.
  5. Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure. The Framingham Study. American Journal of Cardiology 1974; 34:29-34.
  6. Garcia MJ, McNamara PM, Gordon T. 16 year follow up study: morbidity and mortality in diabetics in the Framingham population diabetes. Am J Cardiol 1976;23:105.
  7. From AM, Scott CG, Chen HH. Changes in diastolic dysfunction in diabetes mellitus over time. Am J Cardiol. 2009;103:1463-6.
  8. Van Heerebeek L, Hamdani N, Handoko ML, Falcao-Pires I, Musters RJ, Kupreishvili K, et al. Diastolic stiffness of the failing diabetic heart. Circulation. 2008;117(1):43-51.
  9. Oh JK, Seward JB, Tajik AJ. Assessment of diastolic dysfunction and diastolic heart failure. In: Oh JK, editor. The Echo Manual. 34th ed. New Delhi:Wolters Kluwer;2006:120-41.
  10. Zarich SW, Nesto RW. Diabetic cardiomyopathy. Am Heart J. 1989;118:1000-12.
  11. Cosson S, Kevorkian JP. Left ventricular diastolic dysfunction: an early sign of diabetic cardiomyopathy. Diabetes Metab 2003;29:455- 466.
  12. Zarich SW, Nesto RW. Diabetic cardiomyopathy. Am Heart J 2001;35:166-8.
  13. Schannwell CM, Sehoebel FC Heggen S, Marx R, Perings C, Jackson CV, et al. Early decrease in diastolic function in youngtype 1 diabetic patients as an initial manifestation of diabetic card iomyopathy. Z Kardiol 1999;88:338-346.
  14. Danbauchi SS, Anumah FE, Alhassan MA, David SO, Onyemelukwe GC, Oyati IA. Left ventricular function in type 2 diabetes patients without cardiac symptoms in Zaria, Nigeria. Ethn Dis. 2005;15(4):635–640.
  15. Kannel WB, Hjortland M, Castelli WP. Role of diabetes in conges­tive heart failure: the Framingham study. Am J Cardiol. 1974;34(1): 29–34.
  16. Chaturvedi N, McKeigue PM, Marmot MG, Nihoyannopoulos P. A comparison of left ventricular abnormalities associated with glucose intolerance in African Caribbeans and Europeans in the UK. Heart. 2001;85(6):643–648.
  17. Brownlee M. Advanced protein glycosylation in diabetes and aging. Annu Rev Med. 1995;46:223–234.
  18. Schleicher ED, Wagner E, Nerlich AG. Increased accumulation of the glycoxidation product N(epsilon)-(carboxymethyl)lysine in human tissues in diabetes and aging. J Clin Invest. 1997;99(3):457–468.
  19. 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;24(1):5–10.
  20. Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium. Fibrosis and renin-angiotensin-aldosterone system. Circulation. 1991;83(6):1849–1865.
  21. Ojji D, Parsonage W, Dooris M, et al. Left ventricular diastolic func­tion in normotensive type-2 diabetic subjects. J Natl Med Assoc. 2008;100(9):1066–1072.
  22. Zabalgoitia M, Ismaeil MF, Anderson L, Maklady FA. Prevalence of diastolic dysfunction in normotensive, asymptomatic patients with well-controlled type 2 diabetes mellitus. Am J Cardiol. 2001;87(3): 320–323.
  23. Devereux RB, Roman MJ, Paranicas M, et al. Impact of diabetes on cardiac structure and function: the strong heart study. Circulation. 2000;101(19):2271–2276.

Corresponding Author

Tarkeshwar Kumar

Junior Resident, MD Medicine, Rohilkhand Medical College, Bareilly, India