Preliminary cardiac changes in the prediabetic state by aid of echocardiography and doppler

ABSTRACT

Epidemiological data have long demonstrated a correlation between diabetes and cardiovascular disease which accounts for up to 80% of deaths in patients with diabetes [1]. To elucidate the cardiac structure and function in normotensive patients with type 2 diabetes and impaired glucose tolerant patients in order to assess the effect of diabetes mellitus itself on cardiac function. In addition, to show the relation between the insulin level and sensitivity, and the presence of associated peripheral vascular disease. 15 healthy control subjects; 15 patients with type 2 DM on oral hypoglycemic drugs, and 15 patients with impaired glucose tolerance were randomized from outpatient clinics of Cairo University Hospitals. They were subjected to the following Thorough clinical examination. Serum samples for measurements of Fasting and two hours postprandial blood glucose, fasting serum insulin, glycated hemoglobin [HbA1c], serum creatinine, urea, cholesterol, triglycerides, LDL and HDL cholesterol. Calculation of insulin sensitivity and resistance, electrocardiogram [ECG], resting echocardiography, carotid duplex and ankle brachial indices were performed. There were echocardiographic abnormalities in patients with type 2 DM. These include a- Systolic and diastolic left ventricular function abnormalities, b- Abnormal dimensions of left ventricular mass, aortic root and left atrium. Echocardiographic abnormalities in patients with impaired glucose tolerance include a- Diastolic left ventricular function abnormalities, b- Abnormal dimensions of left ventricular mass, aortic root and left atrium. In type 2 diabetic patients there was a negative correlation between insulin sensitivity measured by HOMA-B and LVDD and IVSD. On the other hand, there was positive correlation between HOMA-R and IVSD and E/A ratio. In patients with impaired glucose tolerance there was a negative correlation between LVDS and insulin sensitivity by HOMA-B method. Insulin resistance is positively correlated with diastolic and systolic left ventricular function abnormalities even in the prediabetic stage. This may represent the first stage of diabetic cardiomyophathy and may contribute to the increased rate of cardiovascular events that has been associated with the cardiovascular metabolic syndrome