Left ventricular diastolic dysfunction in normotensive postmenopausal women with type 2 diabetes mellitus

The prevalence of heart failure among diabetic patients is high, also in those with normal blood pressure and without coronary artery disease, even when electrocardiogram (ECG) is normal. The goal of our study was to assess the prevalence of left ventricular diastolic dysfunction (LVDD) among diabetic women (DW) and its correlation with glycosylated hemoglobin (HbA1c) levels, obesity status, and ECG parameters.

A group of 456 consecutive normotensive postmenopausal women affected by type 2 diabetes, diagnosed over 5 years, were enrolled. One hundred normotensive non-diabetic postmenopausal women were included as a control group (CG). Rest ECG and trans-thoracic echocardiogram and Doppler were performed.

LVDD was present in 103 (23.3%) out of 456 DW, and 8 out of 100 women in CG (8%), p < 0.001. There was no difference in mean age between the two groups: 56 ± 13 and 55 ± 3, respectively (p = 0.3). There were 191 (41.9%) DW with body mass index (BMI) > 30 kg/m². Among those, there were 56 (12.3%) with significant prevalence of LVDD, while there were 49 (10.7%) with BMI < 30 kg/m², p < 0.005. DW with HbA1c > 7.5% comprised a group of 243 (53.3%) patients. Among those, there were 45 (9.9%) with higher prevalence of LVDD, and 15 (3.3%) with HbA1c < 7.5%, p < 0.01. Out of a group of 147 (32.2%) DW with abnormal ECG , 21 had LVDD (4.6%), p = 0,1, and 84 (18.8%) had LVDD with normal ECG.

Our data prove a high prevalence of LVDD in asymptomatic diabetic postmenopausal women. This finding is closely related with HbA1c levels and obesity status, not with abnormal ECG, which is a unique cardiologic test recommended by current guidelines in all diabetic patients. We conclude that early detection of high level of HbA1c and obesity (30 kg/m²) may identify women with major risk to develop LVDD. Furthermore, a simple ECG, when normal, is not enough to assess a normal LV diastolic function.