value of pulsed tissue doppler study in the early diagnosis of diastolic dysfunction in type 2 diabetes mellitus

Cardiovascular disease is the most important cause of mortality and morbidity among patients with type 2 diabetes. Diastolic dysfunction represents the earliest preclinical manifiestataion of diabetic cardiomyopatahy that can progress to sympotomatic heart failure. Transmitral flow Doppler echocardiography is widely used to non-invasively evaluate diastolic function in type 2 diabetic patients, however, this method may give misleading results. Recently, Pulsed Tissue Doppler Imaging [TDIK] has emerged as a new non invasive imaging modality that allows direct online measurement of myocardial velocities throughout the cardiac cycle. The aim of this work is to evaluate the usefulness of pulsed tissue Doppler study of mitral annulus versus transmitral flow Doppler in assessing the diastolic function in type 2 diabetic patients. This study included 4 subjects divided into: 15 patients with type 2 DM having diastolic dysfunction diagnosed by conventional Doppler [group I], and another 15 diabetic patients with normal diastolic function by conventional Doppler [group II], in addition to 10 normal controls [GROUP III]. All patients were subjected to clinical evaluation, laboratory investigations, ECG, echocardiographic assessment and Pulsed Tissue Doppler Imaging of the mitral inflow and mitral annulus with assessment of the transmitral flow veloctities. All partients with diastolic dysfunction diagnosed by conventiaonal Deoppler showed the same abnormality on using TDI, moreover the use of the ratio E[TDI]/A[TDI] by TDI diagnosed 33.33% of group 2 patients to have diastolic dysfunction while they were having normal patterns by conventional Doppler. There were no values in the control group of E[TDI]/A[TDI]<1. Higher values of FBS, PP, HbA1c and triglycerides were associated with impaired LV diastolic performance. Diastolic dysfunction is common in type 2 DM patients specially those with worse glycaemic control. Pulsed TDI of the mitral annulus is more sensitive than conventional Doppler in identifying early LV diastolic dysfunction in type 2 DM patients

Effects of three different sulfonylurea drugs on warm-up phenomenon in type 2 diabetic patients with chronic stable angina pectoris

This study aimed to examine the effects of three different sulfonylureas: Glibenclamide, glicazide and glimepiride, on the warm-up phenomenon by analyzing the results of 2 consecutive exercise tests in diabetic patients with coronary artery disease [CAD]. In subjects with CAD, the angina induced by initial exercise is attenuated with re-exercise after a brief test. This warm-up phenomenon believed to be due to ischemic preconditioning is related to the opening of cardiac ATP-sensitive K channels [K [ATP]]. Blockers of these K[ATP] channels such as the sulphonylurea drugs, can lead to loss of ischemic preconditioning. Forty patients with chronic stable angina: 30 patients having type 2 diabetes mellitus [DM] and 10 non diabetic patients [group D] were enrolled in the study. The DM patients were divided into 3 groups according to the type of sulfonylurea drug they are receiving: Group A [glibenclamide] Group B [gliclazide] and group C [glimepiride]. All patients were subjected to 2 consecutive exercise tests with a 15-minute recovery period between the 2 tests. There was a non significant increase in peak heart rate, systolic blood pressure and rate pressure product during test 2 compared to test 1 in groups B, C and D but not in group A patients. There was a statistically significant increase in the time to onset of typical chest pain [p<0.007 for B, C and <0.005 for D], time to onset of 1mm ST segment depression [p<0.007 for B, C and <0.03 for D] and exercise duration [p<0.01 for B; p<0.08 for C and p<0.02 for D] in test 2 compared to test 1 in groups B, C and D but not in group A patients. There was also a statistically significant decrease in time to ST segment recovery to baseline in test 2 compared to test 1 in groups B, C and D [p<0.005 in the 3 groups] but not in group A patients. Glibenclamide, but not gliclazide or glimepiride abolished the warm-up phenomenon, the clinical counterpart of ischemic preconditioning in type II DM patients with CAD

Vitamin D receptor [VDR] gene polymorphism and risk of osteoporosis in Egyptian post menopausal women

Identifying people at risk of osteoporosis is very important, as prevention is possible. Because genetic factors were shown to have a great influence on osteoporosis susceptibility, their study may be of great help in targeting high-risk individuals. In this work, we studied the association between VDR gene polymorphism and bone mineral density in postmenopausal Egyptian females. 45 Egyptian postmenopausal women [57 +/- 4.6 years] were studied. Bone mineral density was measured at the lumbar spines, the hip, and the lower radius using dual energy X-ray absorptiometry. Ten of the studied patients [22%] had osteoporosis [T or z scores < -2.5]; 21 [47%] had osteopenia [T or z scores -1 to -2.5]; and 14[31%] were normal [T or z scores > -1]. Restriction fragment length polymorphisms in the VDR gene were assessed by PCR amplification and digestion with restriction enzymes FokI, BsmI, ApaI, and TaqI recognizing polymorphic sites in these four VDR gene loci. The BsmI Bb genotype distribution was significantly higher in the normal postmenopausal women [42.9%] than osteopenic women [4.8%] [p value < 0.002]. The TaqI [T] allele was significantly higher in the normal group [68.0%] than the osteopenic group [45.0%] and TaqI [t] which was significantly higher in the osteopenic group [55.0%] than the normal group [32.0%] [p=0.031 for both], otherwise, there was no significant difference in the distribution of other VDR genotypes in relation to bone density measurement. The higher distribution of the VDR BsmI Bb and TaqI T genotype in the normal postmenopausal than osteopenic women may reflect a protective role, on the other hand, TaqI t allele may be associated with lower bone mineral density in postmenopausal Egyptian females