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الاختلال الانبساطي الوظيفي للبطين الايسر عند مرضى داء السكري من النوع الثاني == The Left Ventricular Diastolic Dysfunction In Asymptomatic Type 2 Diabetes Mellitus Patients
Author name:
الاء سعد عادل
Supervisor name:
اسماعيل ابراهيم حسين القرغولي | عباس ناجي مسلم الشريفي
General topic:
Medicine
Specific topic:
Medicine
Degree:
Master
University:
Mustansiriyah University
Language:
English
University location:
Baghdad
First pages:
19T1160 - p.pdf
Abstract:
نسبة الاختلال الانبساطي الوظيفي للبطين الايسر عند مرضى داء السكري من النوع الثاني والكشف عنها بواسطة فحص الدوبلر النسيجي هدف الدراسة : للبحث عن نسبة الاختلال الانبساطي الوظيفي للبطين الايسر والذي يعد كعامل خطورة على وظائف القلب والاوعية الدموية عند مرضى | Our study about the left ventricular diastolic dysfunction in asymptomatic type 2 diabetic patients, detected by 2 - D and tissue Doppler echocardiography. Type 2 diabetes mellitus (T2DM) is the most common chronic disease, with several complications, affecting all systems and ages. The trends towards improving the longevity in diabetes are achieved by the glycemic control and prevention of complication. Left ventricular diastolic dysfunction (LVDDX) refers to mechanical abnormalities that impede effective volume filling during diastole. It has been described as an early sign of diabetic cardiomyopathy preceding the systolic damage. It can lead progressively to heart failure and is linked to increased mortality.Objective : The aim of this study is to estimate the percentage of left ventricular diastolic dysfunction in asymptomatic patients with type 2 diabetes mellitus detected by 2 - D and tissue Doppler echocardiography.Setting : This study is conducted by the department of physiology, college of medicine, Al - Mustansirirya university in cooperation with the unit of Echocardiography at Al - Yarmouk Teaching Hospital in Baghdad during the period from November 2013 to July 2014. Patients and methods : A total number of 130 subject were examined, where 38 were excluded and only 92 were included in this study, about 46 healthy subjects (control group) (with mean age of 47.07±7.6 year) and 46 patients with T2DM (with mean age of 49.39±5.7 year).Main outcome measures : The plan of the study consisted of the following steps : 1. History interview2. Physical examination3. Physical measurements including : body mass index (BMI), neck circumference (NC), waist circumference (WC), hip circumference (HC) , mid thigh circumference (MTC) calculation by measuring tape.4. Electrocardiography5. Conventional echocardiography and TDI6. Blood sample for hemoglobin A1C (HbA1c), fasting blood sugar (FBS), lipid profile.Results : Our study showed structural and functional changes in the left ventricle in a sample of diabetic patients. Diastolic dysfunction presents in 69.6% of diabetic patients, 41% were males and 59% were females. The mean age of the diabetic patients was 49±5.7 year. The mean duration of diabetes in asymptomatic normotensive type 2 diabetic patients was 7.6 ± 6.4 year. By TDI the diabetic patients in comparison to control group show lower E` average velocity (8.9±1.9 Vs 10.7±1.6 cm/sec)(P<0.0001), higher E/E` average ratio (7.4±1.7 Vs 6.4±1.3cm/sec) (P<0.04), lower E`/A` ratio (0.8±0.3 Vs 1.02±0.3)(P<0.004). While by conventional echo the diabetic patients show lower E velocity (63.7±13.4 Vs 72±19.9cm/sec) (P<0.01) and lower E/A ratio (0.9±0.3 Vs 1.17±0.4) (P<0.0001). Biochemical analysis show lower HDL (1.1±0.2mmol/l)(P<0.0001) and higher TG/HDL (1.8±1.4)(P=0.025). The study showed that diabetic patients had higher BMI 30.6±5.5 kg/m2 (P=0.052), higher neck circumference (40.4±3.9 cm) (P=0.034) and higher waist circumference (105.7±11.7 cm)(P<0.0001). All other values were not significant. Our study revealed that the highest percentage of LV diastolic dysfunction found in the group of diabetic patient with the highest duration of type 2 DM disease. The study revealed some correlations between some parameters of the study like : the duration of T2DM was positively correlated with A velocity (r= 0.29, p= 0.048), FBS was negatively correlated with A velocity (r= - 0.39, p= 0.008), FBS was negatively correlated with LVEDD (r= - 0.29, p= 0.049), FBS was negatively correlated with neck circumference (r= - 0.48, p= 0.0008), HDL was negatively correlated with IVS thickness (r= - 0.567, p= 0.00003) and mid - thigh circumference was positively correlated with A` average velocity (r= - 0.39, p= 0.008)Conclusion : 1. Type - 2 diabetes Mellitus is associated with a higher percentage of left ventricular diastolic dysfunction which is increased with the increased duration of DM. 2. Tissue Doppler echocardiography is a valuable tool in detecting LV diastolic dysfunction in asymptomatic normotensive diabetic patients with non significant features on conventional echocardiography.3. TDI is more sensitive and specific in detecting LV diastolic dysfunction in asymptomatic type 2 DM than pulsed wave flow Doppler.
