Diagnostic value of B-natriuretic peptide, ankle brachial index and carotid doppler in detection of sub-clinical cardiovascular disease in type 2 diabetic patients

Diabetes is important as a cause of cardiovascular disease [CVD], ranging from asymptomatic ischemia to clinically evident heart failure. Therefore, early identification of sub-clinical CVD in diabetic patients may be particularly important in leading to early initiation of treatment. The aim of the present study was to identify role of BNP [Brain natriuretic Peptide]. Ankle Brachial Index [ABI] and carotid Doppler in detection of sub-clinical CVD in type 2 diabetic patients. BNP was measured in 60 consecutive diabetic patients [patients group] whom were attended internal medicine outpatient clinics or admitted at endocrinology unit of Assiut university hospital. Another 40 patients; were chosen as [control group] their age and sex matched with patients. Echocardiography examinations were performed to all participants. ABI measurements were eonducted on all study participants. Carotid intima Media Thickness [CIMT] and carotid Plaque were evaluated by Carotid Doppler Ultrasonography, along with the determination of anthropometric parameters, HbAlc, lipid profile, assessment of diabetic retinopathy, nephropathy, and neuropathy, in patients with type 2 diabetes mellitus [T2DM]. Our study revealed 11 patients had Left ventricular hypertrophy [LVH], 20 patients had Left Ventricular Diastolic Dysfunction [LVDD], and no systolic dysfunction were detected. BNP were independent determinants of mild to moderate LVDD. Prevalence of a low ABI [<0.9] was 18.3%. Patients with low ABI had significant increased mean ages [P=0.038] duration of DM [P=0.004], concentration of HbAlc [P=0.044], BNP [P=0.013] and microalbuminurea [P-0.007].Patients with low ABI significantly associated with nephropathy [P=0.001], retinopathy [P=0:007], LVH [P=0.010] LVDD [P=0.018] and carotid artery atherosclerosis [P=0.018]. 20 patients [33.3%] were found to have evidence of carotid artery disease of them 5 patients [8.3%] had increased CIMT and 15 patients [25%] had carotid artery plaques, patients with carotid plaque were significantly smoker [P=0.008], male gender [P=0.013], had low HDL [P-0.008] and higher concentration of HbAlc [P=0.001]. Also patients with carotid artery atherosclerosis were significantly associated with nephropathy [P=0.000], neuropathy [P=0.050], Peripheral Arterial Disease [PAD] [P=0.018], LVDD [0.002].Conclusion: Our study showed that BNP discriminated patients at high risk for mild to moderate LVDD. A low ABI were prevalent in our study and associated with age, duration of diabetes, high HbAlc, microalbuminurea and chronic complication of DM, also carotid atherosclerosis high prevalent in our study especially carotid plaques which significantly associated with male gender, smoking, high HbAlc, low HDL, LVDD, PAD, and diabetic microangiopathy

QT dispersion in type 2 diabetic patients

Diabetes mellitus is one of the most common causes of patient contact with a physician, and is a major cause of premature disability and mortality. Several studies have described a poor survival prognosis in type 2 diabetic patients compared with non-diabetic populations. It has been postulated that QT prolongation and QT dispersion [QTd]. predispose to cardiac arrhythmias and sudden death. The aim of our study was to detect the relationship between [QT corrected] QTc and QTd with type 2 diabetes mellitus. This study included eighty subjects divided into two groups; Group I: included sixty patients with type 2 diabetes and group II: included twenty healthy controls. All subjects were subjected to the following: Careful history taking and clinical examination, assessment of BMI, assessment of cardiovascular autonomic function tests and laboratory investigations including fasting and postprandial blood glucose levels, blood urea and serum creatinine levels, lipid profile, serum electrolytes [Na, K and Ca levels] and electrocardiography [ECG] for measurement of QT interval and calculation of QTc and QTd. The results of our study revealed that QTc and QTd was significantly increased in diabetic patients compared to non-diabetic controls. QTd was significantly related to QTc. QTc and QTd have no relation to the patient's gender. QTc was significantly related to BMI, type of therapy, fasting blood glucose and triglycerides. QTd was significantly related to the patients age, fasting and posiprandial blood glucose levels, triglycerides, HDL-c, type of therapy, presence of cardiac autonomic neuropathy and smoking. QT dispersion should now, be used as a screening test, and those with high QTd should undergo extensive cardiac examinations to identify reversible contributors to future cardiac death, with particular emphasis on examination designed to detect underlying cardiac ischemia. Recommendations: We recommend extending this study to be done on a wider scale and a big number of diabetic patients with different diabetic complications in order to study the correlation of QTc and QTd with diabetic complications