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

ABSTRACT

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