FREQUENCY OF DIASTOLIC DYSFUNCTION IN ASYMPTOMATIC, NORMOTENSIVE TYPE-2 DIABETIC PATIENTS
Abstract
Background: Diabetes mellitus affects heart in multiple ways and can affect virtually any part of heart specifically cardiac myocardium. Hence this involvement can severely affect the cardiac contractility resulting in severely debilitating symptoms of cardiac failure and hampering life. Early diagnosis therefore is of paramount importance as it can enable early diagnoses and treatment to counter the irreversible damage to the cardiac contractility dysfunction. The objective of this study was to determine the frequency of diastolic dysfunction in asymptomatic normotensive type-2 diabetics. Methods: In this descriptive case series, 150 consecutive patients with type-2 diabetes mellitus having normal blood pressure and normal resting electrocardiogram and without any symptoms of heart failure were selected from diabetes management center and Doppler echocardiography was performed. Pulmonary venous flow recordings were also obtained from the four-chamber view directed at the right upper pulmonary vein. Presence or absence of diastolic dysfunction will be documented in each case. Valsalva maneuver was used to unmask pseudo-normal patterns of ventricular filling. Results: Of the total, 72(48%) of patients had diastolic dysfunction. Conclusion: Type-2 diabetes mellitus is associated with diastolic dysfunction in the absence of other causes of diastolic dysfunction.Keywords: Diabetes Mellitus, Type-2, Diastolic dysfunction, NormotensiveReferences
Khan Z, Iqbal MA, Nadeem MA, Shoaib S. Rosiglitazone and Metformin in patients with type-2 Diabetes Mellitus who are inadequately controlled on Metformin alone. Ann King Edward Med Uni 2005;11:20–3.
Nagra MH, Bilal A , Shahid M, Amin K. Incidence of Ischemic Heart Disease in patients with non insulin dependent Diabetes Mellitus. Professional Med J 2004;11:320–7.
Aamir AH. Targets for treating type-2 diabetes and preventing its complications: can we achieve it? Pak J Med Res 2004;43:95–6.
Boyer JK, Thanigaraj S, Schechtman KB, Perez JE. Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Am J Cardiol 2004;93:870–5
Fang ZY, Yuda S, Anderson V, Short L, Case C, Marwick TH. Echocardiographic detection of early diabetic myocardial disease. J Am Coll Cardiol 2003;41:611–7.
Ali L, Abid AR, Mohyuddin MT, Azhar M. Echocardiographic evaluation of patients with diastolic dysfunction. Pak J Cardiol 2005;16:143–8.
Gull A, Rehman A, Jalil A. Changes in glycosylated proteins in type-2 diabetic patients with and without complications. J Ayub Med Coll Abbottabad 2005;17(3):33–7.
Cosson S, Kevorkian JP. Left ventricular diastolic dysfunction: an early sign of diabetic cardiomyopathy? Diabetes Metab 2003;29:455–66.
Cakir M, Baskal N, Güllü S, Erdogan M, Atilla E, Erol Ç, et al. Microalbuminurea, nondipping and diastolic dysfunction in normotensive type 2 diabetic Patients. Turk J Endocrinol Metab 2003;1:23–9.
Zaalgoitia M, Ismaeil MF, Anderson L, Maklady FA. Prevalence of diastolic dysfunction in normotensive, asymptomatic patients with well-controlled type 2 diabetes mellitus. Am J Cardiol 2001;87:320–3.
Poirier P, Bogaty P, Garneau C, Marois L, Dumesnil JG. Diastolic dysfunction in normotensive men with well controlled type 2 diabetes. Diabetes Care 2001;24:5–10.
Hameedullah, Faheem M, Bahadar S, Hafizullah M, Najeeb S. Effect of glycaemic status on left ventricular diastolic function in normotensive type 2 diabetic patients. J Ayub Med Coll Abbottabad 2009;21(3):139–44.
Ali L, Abid AR, Azhar M. Risk factors of Diastolic heart failure; an epidemiological analytic study. Professional Med J 2006;13:410–6.
Najafian J, Khaledian MR, Farahnaz F. A study of the relationship between myocardial performance index and left ventricular end-diastolic pressure in patients with left ventricular systolic dysfunction. Pak J Cardiol 2006;17:57–9.
Khan AR, Khan MQ. Association and pattern of Diastolic dysfunction in patients of metabolic syndrome. J Ayub Med Coll Abbottabad 2008;20(2):70–5.
Schannwell CM, Schneppenheim M, Perings S, Plehn G, Strauer BE. Left ventricular diastolic dysfunction as an early manifestation of diabetic cardiomyopathy. Cardiology 2002;98:33–9.
Carugo S, Giannattasio C, Calchera I, Paleari F, Gorgoglione MG, Grappiolo A, et al. Progression of functional and structural cardiac alterations in young normotensive uncomplicated patients with type 1 diabetes mellitus. J Hypertens 2001;19:1675–80.
Beljic T, Miric M. Improved metabolic control does not reverse left ventricular filling abnormalities in newly diagnosed non-insulin-dependent diabetes patients. Acta Diabetol 1994;31:147–50.
Boyer JK, Thanigaraj S, Schechtman KB, Pérez JE. Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Am J Cardiol. 2004;93:870–5.
Boudina S. Clinical manifestations of diabetic cardiomyopathy. Heart Metab 2009;45:10–4.
Ozasa N, Furukawa Y, Morimoto T, Tadamura E, Kita T, Kimura T. Relation among left ventricular mass, insulin resistance, and hemodynamic parameters in type 2 diabetes. Hypertens Res 2008;31:425–32.
Ashraf S, Basir F. Association of hypertension and diastolic dysfunction with type-2 diabetes mellitus. Pak J Med Sci 2007;23(3):344–8.
Annonu AK, Fattah AA, Mokhtar MS, Ghareeb S, Elhendy A. Left ventricular systolic and diastolic functional abnormalities in asymptomatic patients with non-insulin-dependent diabetes mellitus. J Am Soc Echocardiogr 2001;14:885–91.
Poirier P, Bogaty P, Garneau C, Marois L, Dumesnil JG. Diastolic dysfunction in normotensive men with well controlled type 2 diabetes: importance of maneuvers in echocardiographic screening for preclinical diabetic cardiomyopathy. Diabetes Care 2001;24:5–10.
Yudkin JS. The United Kingdom Prospective Diabetes Study – everything you needed to know about diabetes but were afraid to ask? Eur Heart J 1999;20:781–3.
Yudkin JS. Vascular events and diabetes: acute myocardial infarction and stroke. In: Alberti KG, Zimmet P, DeFronzo RA, Keen H, editors. International textbook of diabetes. Chichester (UK): Wiley; 1997.p.1255–79.
Zabalgoitia M, Ismaeil MF, Anderson L, Maklady FA. Prevalence of diastolic dysfunction in normotensive, asymptomatic patients with well-controlled type 2 diabetes mellitus. Am J Cardiol 2001;87:320–3.
Bajraktari G, Qirko S, Rexhepaj N, Bakalli A, Beqiri A, Elezi S, et al. Non-Insulin Dependent Diabetes as an Independent Predictor of Asymptomatic Left Ventricular Diastolic Dysfunction Croat Med J 2005;46:225–31.
Di Carli MF, Bianco-Batlles D, Landa ME, Kazmers A, Groehn H, Muzik O, et al. Effects of autonomic neuropathy on coronary blood flow in patients with diabetes mellitus. Circulation 1999;100:813–9
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.