Echocardiographic evaluation of diastolic dysfunction in asymptomatic type 2 diabetes mellitus

Diabetes mellitus is one of the most common diseases in the world and is acquiring epidemic proportions. Its prevalence is growing in both developed and developing countries. 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. There is an increased rate of ischemic heart disease and cardiomyopathy which may lead to heart failure (Diastolic heart failure). Left ventricular diastolic dysfunction represents an early stage of heart failure, without any clinical manifestations. In the view of these above facts the present study was done to assess the diastolic dysfunction in diabetic patients.

A cross-sectional hospital-based study was done which included 50 asymptomatic patients with type 2 diabetes mellitus without evidence of cardiovascular involvement and blood pressure less than 130/80 mmHg were studied. LVDD was evaluated by Doppler echocardiography, which included E/A ratio; left atrial size was assessed in relation with age/sex, duration of diabetes and HbAlc level.

Results showed that diastolic dysfunction was present in 32 (64%) of the patients. Diastolic dysfunction was more common among female sex (68.18%) compared to male (60.17%). Diastolic dysfunction was significantly associated with uncontrolled diabetes as assessed by HbA1c levels. Diastolic dysfunction was more common in patients who were on treatment with both oral hypoglycemic agents and insulin. The prevalence of diastolic dysfunction increased with longer duration of diabetes. There was a linear progression of diastolic dysfunction with the increase age group.

The findings in our study indicate that myocardial damage in patients with diabetes affects diastolic dysfunction before systolic function. E/A ratio and Left atrial size are significantly altered in diabetic patients with diastolic dysfunction. Diastolic dysfunction is significantly associated with duration of disease, glycemic levels and the type of treatments. Doppler Echocardiography is a simple non invasive valuable tool in diagnosing diastolic dysfunction. In diabetics before they develop cardiac symptoms it has to be done routinely on every diabetic patients to assess the cardiac function.