Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, 249203, Uttarakhand, India.
Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, 249203, Uttarakhand, India.
Indian Heart J. 2023 Nov-Dec;75(6):451-456. doi: 10.1016/j.ihj.2023.10.005. Epub 2023 Oct 18.
Diabetic cardiomyopathy, which involves both the right and left ventricles, progresses from a preclinical stage to overt heart failure. Detection of this entity at a preclinical stage could be crucial in intervening to halt its progression to overt heart failure. There is a paucity of literature on subclinical RV dysfunction in diabetic patients, and it is even rarer in the Indian literature. Our study intended to study this clinical entity through an echocardiographic assessment of asymptomatic patients.
This was a cross-sectional observational analytic study, comparing subclinical RV dysfunction in diabetic and non-diabetic subjects by using echocardiography as a primary objective, while the secondary objective of the study was to find out the correlation between RV dysfunction and the duration of diabetes mellitus and HbA1C levels.
Conventional echocardiography with tissue Doppler imaging (TDI) was used to measure nine different echocardiographic parameters in the diabetic and non-diabetic groups. All probable causes of RV dysfunction were excluded before enrolling the patients in the study. Unpaired t-test was used to compare the parameters between the two groups, and multivariate regression analysis was done taking into consideration age, duration of diabetes, and HbA1C levels as the independent variables, and echocardiographic parameters as the dependent variables.
Out of the nine different echocardiographic parameters, Tricuspid annular plane systolic excursion (TAPSE), RV end diastolic diameter (RVEDD), Tricuspid peak late diastolic velocity (A), E/A ratio, RV basal segment peak myocardial systolic velocity (Sm), RV basal segment peak early diastolic velocity (Em), RV basal segment peak late diastolic velocity (Am), and E/Em ratio showed statistically significant differences between the two groups. These results show the presence of subclinical RV dysfunction in diabetic patients. TAPSE and E/A ratio showed a significant correlation with the duration of diabetes, while Em showed a significant correlation with HbA1C.
Diabetes mellitus is associated with subclinical systolic as well as diastolic RV dysfunction. In addition to helping identify people at high risk, the early recognition of RV dysfunction gives us a window of opportunity to take action and slow down the disease's course. This study emphasizes that the early identification of RV diastolic as well as systolic dysfunction in asymptomatic Type 2 diabetic patients can be a helpful tool in halting the progression of disease from subclinical to frank clinical cases, thereby preventing the morbidity and mortality associated with heart failure. Hence, it adds value to the pre-existing literature.
糖尿病性心肌病累及左右心室，从临床前期进展为心力衰竭。在临床前期检测到这种疾病对于干预以阻止其进展为心力衰竭至关重要。关于糖尿病患者亚临床右心室功能障碍的文献很少，而在印度文献中更是罕见。我们的研究旨在通过对无症状患者的超声心动图评估来研究这一临床实体。
这是一项横断面观察性分析研究，通过超声心动图作为主要目标比较糖尿病和非糖尿病患者的亚临床右心室功能障碍，研究的次要目标是找出右心室功能障碍与糖尿病病程和糖化血红蛋白（HbA1C）水平之间的相关性。
使用组织多普勒成像（TDI）对糖尿病和非糖尿病组的 9 种不同超声心动图参数进行常规超声心动图检查。在将患者纳入研究之前，排除了所有可能导致右心室功能障碍的原因。使用独立样本 t 检验比较两组之间的参数，考虑年龄、糖尿病病程和 HbA1C 水平作为自变量，超声心动图参数作为因变量进行多元回归分析。
在 9 种不同的超声心动图参数中，三尖瓣环平面收缩期位移（TAPSE）、右心室舒张末期直径（RVEDD）、三尖瓣瓣环舒张晚期峰值速度（A）、E/A 比值、右心室基底段心肌收缩期峰值速度（Sm）、右心室基底段舒张早期速度（Em）、右心室基底段舒张晚期速度（Am）和 E/Em 比值在两组之间有统计学差异。这些结果表明糖尿病患者存在亚临床右心室功能障碍。TAPSE 和 E/A 比值与糖尿病病程有显著相关性，而 Em 与 HbA1C 有显著相关性。
糖尿病与亚临床收缩和舒张右心室功能障碍有关。除了有助于识别高危人群外，早期识别右心室功能障碍为我们提供了一个采取行动减缓疾病进程的机会。这项研究强调，在无症状 2 型糖尿病患者中早期识别右心室收缩和舒张功能障碍，可以成为阻止疾病从亚临床向临床病例进展的有用工具，从而预防与心力衰竭相关的发病率和死亡率。因此，它为现有文献增加了价值。
