Pre-Clinical Diastolic Dysfunction in Diabetes Mellitus
Journal Title: Journal of Medical Science And clinical Research - Year 2017, Vol 5, Issue 2
Abstract
Background: Studies have reported a high prevalence of pre-clinical diastolic dysfunction among patients with DM. Diabetic patients are often complicated by subsequent development of heart failure, maybe primary or secondary to hypertension / CAD. Abnormalities of both systolic and diastolic performance in diabetic subjects have been demonstrated in various human studies. However, diastolic dysfunction precedes systolic dysfunction. Studies in the West have demonstrated a direct correlation between duration of diabetes and diastolic dysfunction. Hence we attempted to identify the correlation between duration of diabetes mellitus and subsequent LV diastolic dysfunction (E/e’ ratio) by conventional and tissue doppler imaging in our local population. Methods: We retrospectively identified all diabetic patients with a Doppler mitral valve imaging (both transmitral and tissue doppler) assessment of diastolic dysfunction at Sri Ramachandra Medical College, Chennai from January – May 2015. Overall, 112 diabetic patients were identified and subjected to a tissue Doppler echocardiographic assessment of diastolic dysfunction after obtaining informed consent. Diastolic dysfunction was defined as Ratio of a passive transmitral left ventricular (LV) inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (E/e’) ratio >15. Patients with coronary disease, hypertension, high body mass index, heart failure, mitral valve or aortic valve regurgitation or stenosis were excluded. Results: Of the 112 patients identified, no patient withdrew his/her consent. 69 male patients and 43 female patients were identified with a mean age of 55 years. Of these 51 patients had an average duration of diabetes for more than 4 years.42 (38.4%) patients among this group had diastolic dysfunction (i.e.) E/e’ ratio of > 15. Patients with diabetes of less than 4 years’ duration had either normal or intermediate level of diastolic dysfunction. Using Chi-square test, we determined that there is a significant association between duration of diabetes and development of diastolic dysfunction (E/e’) (x2 = 107.974, Df = 4, 0.000<0.05 significant) in the patients with diabetes for more than 4 years. Conclusion: Our current study demonstrates that pre-clinical diastolic dysfunction is high in DM patients and there is a direct correlation between duration of DM and diastolic dysfunction. Significant diastolic dysfunction occurs 4 years after the onset of DM independent of coronary disease or hypertension. Such patients must be advised regarding strict glycaemic control and followed up for development of frank diastolic dysfunction
Authors and Affiliations
Dr K Madhavan
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