ECHOCARDIOGRAPHIC EVALUATION OF DIASTOLIC DYSFUNCTION IN ASYMPTOMATIC TYPE 2 DIABETES MELLITUS

Diabetes mellitus is one of the most common diseases in the world and is acquiring epidemic proportions. Its prevalence is growing in both developed and developing countries. India is the Diabetic Capital Of the world. Indians are genetically more susceptible to diabetes compared to other races. Cardiovascular complications are known to be the main cause of morbidity and death in diabetic patients. In diabetic patients there is an increased rate of ischemic heart disease and cardiomyopathy which may lead to heart failure (Diastolic heart failure). Despite similar left ventricular systolic function, patients with diabetes have more pronounced heart failure symptoms, use more diuretics, and have an adverse prognosis compared with those without diabetes; one putative explanation for these discrepancies is diastolic dysfunction of the left ventricle in diabetes mellitus. Left ventricular diastolic dysfunction represents an early stage of heart failure, without any clinical manifestations. In the view of these above facts the present study was conducted to assess the diastolic dysfunction in diabetic patients. MATERIAL AND METHODS: This cross sectional study comprising 50 cases was conducted in the Department of Medicine, Pt. Jawaharlal Nehru Memorial Medical College and Dr. B.R.A.M. Hospital, Raipur (C.G.) from July 2013 to July 2014 in diabetic patients without evidence of cardiovascular involvement and blood pressure less than 140/90mmHg were studied. Permission of ethical committee was taken. 26 patients were female and 24 were male. LVDD was evaluated by Doppler echocardiography, which included E/A ratio; left atrial size was assessed in relation with age/sex, duration of diabetes and HbA1c level. RESULTS: Results showed that diastolic dysfunction was present in 35 (70 %) of the patients. Among males diastolic dysfunction was present in 17 cases (70.83%). Among females diastolic dysfunction was present in 18 cases (69.23%). Diastolic dysfunction was associated with uncontrolled diabetes as assessed by HbA1c levels. Diastolic dysfunction was more common in patients who were on treatment with both oral hypoglycemic agents and insulin. The prevalence of diastolic dysfunction increased with longer duration of diabetes. There was a linear progression of diastolic dysfunction with the increase in age and those with more Left Atrial size. CONCLUSION: The findings in our study indicate that myocardial damage in patients with diabetes affects left ventricular diastolic function before systolic function. E/A ratio and Left atrial size are significantly altered in diabetic patients with diastolic dysfunction. Diastolic dysfunction is significantly associated with duration of diabetes, glycemic levels and the type of treatments. Onset of diastolic dysfunction occurs earlier in females as compared to males. Doppler Echocardiography is a simple, noninvasive, cheap, easily available and a valuable tool in diagnosing diastolic dysfunction. In diabetics before they develop cardiac symptoms, Echocardiography should be done routinely on every diabetic patients to assess the cardiac function.