Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, India.
Division of Diabetes and Metabolism (Department of Internal Medicine), All India Institute of Medical Sciences (AIIMS), Rishikesh, India.
Diab Vasc Dis Res. 2020 Jul-Aug;17(4):1479164120944134. doi: 10.1177/1479164120944134.
The primary objective of the study was to estimate the prevalence of sub-clinical left ventricular dysfunction among asymptomatic diabetic patients, while the secondary objectives were to determine its association with microvascular complications and to find correlation with the baseline clinical and demographic parameters.
This was a cross-sectional study conducted on 226 type 2 diabetic patients who did not have any diagnosed cardiac disease, baseline ECG abnormality or cardiac symptoms. Two-dimensional strain echocardiography was performed to estimate the prevalence of left ventricular systolic dysfunction by measuring global longitudinal strain rate (cutoff < 18). Its association with microvascular complications was analysed with SPSS 23 software. Other baseline clinical parameters and demographic profile were also analysed.
Among 226 patients (151 males, 75 females), cardiac abnormality was found in 29.2% patients. Diabetic microvascular complications (e.g. neuropathy, retinopathy and nephropathy) were strongly associated with it (each with < 0.0001) in addition to dyslipidaemia, history of hypertension, higher body mass index and poor glycaemic parameters. Among them, proteinuria showed a linear inverse relationship without any specific cutoff value.
It was found that sub-clinical left ventricular dysfunction was found in significantly high proportion among patients with microvascular complications. Hence, routine screening of all diabetics for such complications and subsequently high-risk patients undergoing strain echocardiography can be a very cost-effective diagnostic, therapeutic and prognostic modality.
本研究的主要目的是评估无症状糖尿病患者亚临床左心室功能障碍的患病率，次要目的是确定其与微血管并发症的关系，并找到与基线临床和人口统计学参数的相关性。
这是一项横断面研究，共纳入 226 例无诊断性心脏病、基线心电图异常或心脏症状的 2 型糖尿病患者。通过测量整体纵向应变率（<18），使用二维应变超声心动图评估左心室收缩功能障碍的患病率。使用 SPSS 23 软件分析其与微血管并发症的关系。还分析了其他基线临床参数和人口统计学特征。
在 226 例患者（151 例男性，75 例女性）中，有 29.2%的患者存在心脏异常。糖尿病微血管并发症（如神经病变、视网膜病变和肾病）与左心室功能障碍密切相关（均<0.0001），此外还与血脂异常、高血压史、较高的体重指数和较差的血糖参数有关。其中，蛋白尿呈线性反比关系，无特定的截断值。
研究发现，有微血管并发症的患者中存在亚临床左心室功能障碍的比例显著较高。因此，对所有糖尿病患者进行此类并发症的常规筛查，随后对高危患者进行应变超声心动图检查，可能是一种非常具有成本效益的诊断、治疗和预后手段。
