Study of Left ventricular Diastolic Dysfunction in Normotensive Type 2 Diabetes Mellitus in Western Rajasthan
Abstract
Diabetes Mellitus (DM) is one of the major risk factors for diastolic heart failure (DHF). So this study was undertaken on 75 cases of type 2 Diabetes Mallitus and 75 matched healthy controls to study the diastolic dysfunctions in normotensive type 2 Diabetes Mellitus. Normotensive type 2 Diabetes Mellitus 61.33%) showed LVDD in 61.33% which was significantly higher than in matched normal control where it was 6.67%. LVDD was found significantly more in elder age, with longer duration of disease and higher HbA1C. Mean of E/A ratio in case group was significantly lower as compared to control group. The case group also showed prolonged IVRT and DT in comparison to control as the p value was statistically significant (p<0.01).
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Introduction
Diabetes mellitus (DM) refers to a group of common metabolic disorder that shares phenotype of hyperglycaemia. The incidence of diabetes mellitus (DM) is increasing worldwide. The Indian Council of Medical Research-Indian Diabetes Study 2011 (ICMR- INDIAB) estimates that currently India has 62.4 million people with DM. The majority (>90%) of them have Type 2 DM. 1 It is predicted that by 2030 diabetes mellitus may afflict up to 79.4 million individuals in India. According to the International Diabetes Federation (IDF) (2015) 415 million people in the world live with diabetes. 2
DM is one of the major risk factors for diastolic heart failure (DHF). Over the last three decades, a number of epidemiological, clinical and autopsy studies have proposed the presence of diabetic heart disease as a distinct clinical entity. Diastolic heart failure (DHF) is also referred to as HF, with preserved left ventricular systolic function. Many studies have reported that the incidence of heart failure in diabetic subjects is high even in the absence of hypertension and coronary artery disease. Studies have also reported a high prevalence of pre-clinical diastolic dysfunction among subjects with DM. 3
Left ventricular diastolic dysfunction (LVDD) represents the first stage of diabetic cardiomyopathy preceding changes in systolic function, reinforcing the importance of early evaluation of ventricular function in individuals with diabetes. 4,5 The diastolic abnormalities are present in diabetic patients in absence of diabetic complications of cardiovascular system. 6-8
Presently very few studies have been carried out in India to study the relation between diastolic dysfunction in DM (type2). So the present study was undertaken to evaluate left ventricular dysfunction in Normotensive type 2 Diabetes mellitus patients. So this case control study was conducted to study the diastolic dysfunctions in normotensive type 2 Diabetes Mellitus.
Conclusion
Left ventricular dysfunction is prevalent among type II diabetic patients in Western Rajasthan without symptomatic heart disease. Echocardiography is of immense benefit in the management of type II DM patients as this will enhance early detection of left ventricular dysfunction with a view to early treatment in order to reduce morbidity and mortality. Limitations of the study:- Stress electrocardiography, myocardial perfusion imaging, and coronary angiography were not used to exclude sub clinical coronary disease.