Echocardiographic evaluation of diastolic dysfunction in normotensive patients with type-2 diabetes mellitus

ABSTRACT

Diastolic dysfunction in diabetic patients is believed to represent an earlier stage in the natural history of diabetic cardiomyopathy. Previously published reports on the prevalence of LV diastolic dysfunction in diabetics are conflicting, mainly because of the confounding effect of systemic hypertension and coronary artery disease [CAD] and neglecting to account for pseudonormal patterns of ventricular filling. This study was conducted to estimate the prevalence of diastolic functions in patients with type-2 diabetes without co-existing hypertension or known CAD and to assess the risk factors for the development of diastolic dysfunction in such patients. A total of 100 normotensive patients with type-2 diabetes without any history of cardiac illnesses and 50 age and sex matched healthy controls, were enrolled in this work. All patients and controls underwent conventional Doppler echocardiography, color M-mode echocardiography and tissue Doppler imaging [TDI]. In the diabetic group, 76% had diastolic dysfunction. Impaired relaxation and pseudonormal filling pattern were observed in 30% and 46% of our diabetics respectively. On the other hand, impaired relaxation and pseudonormal filling pattern were observed in 8% and 2% of the controls. The diabetics with diastolic dysfunction were older and had more central obesity than those with normal diastolic function. Both age and waist circumference were associated with the presence of diastolic dysfunction but age was the only independent risk factor for such condition. The prevalence of diastolic dysfunction is very high in normotensive type-2 diabetics, who are free of clinically detectable heart disease. Patient's age appears to be an independent risk factors for such condition in such patients