G. Anil Kumar1, Hema S. Bhaskar2
Congestive heart failure is the final result of cardiovascular complications in diabetes mellitus, in which the diastolic dysfunction is impaired earlier than the systolic function. Diastolic dysfunction may be asymptomatic without signs of overt heart failure.
A cross-sectional hospital based study was done which included 50 asymptomatic patients with type 2 diabetes without evidence of coronary artery disease, congestive heart failure or thyroid disease. LV diastolic dysfunction was evaluated by Doppler echocardiography, which included the Valsalva manoeuvre to unmask the pseudonormal pattern of left ventricular filling. The prevalence of diastolic dysfunction and the associated risk factors were assessed.
LVDD was found in 35 subjects (71%), of whom 30 had impaired relaxation and 5 had a pseudonormal pattern of ventricular filling. Systolic function was normal in all subjects, and there was no correlation between LVDD and indexes of metabolic control. It was also found that age ≥46 years was associated with an almost three times higher risk for the development of diastolic dysfunction in type 2 diabetes. Especially females were at two times higher risk of developing diastolic dysfunction than when compared to men. Duration of diabetes ≥ two and half years was associated with a two times higher risk for developing diastolic dysfunction.
LV Diastolic dysfunction is much more common than previously assumed in subjects with well-controlled type 2 diabetes who are without any clinically detectable cardiac disease. The high prevalence of this phenomenon in this high-risk population suggests that screening for LVDD in type 2 diabetes should be routinely done & must include procedures such as the Valsalva manoeuvre to unmask a pseudonormal pattern of ventricular filling.