Role of Echocardiography in Detecting Left Ventricular Dysfunction Among Diabetic Patients: A Clinical and Biochemical Perspective.

BACKGROUND

Diabetes mellitus (DM) increases the risk of left ventricular dysfunction (LVD), which can progress to heart failure if undetected. Echocardiography, a non-invasive and cost-effective imaging tool, provides real-time assessment of left ventricular (LV) function and enables early detection of myocardial dysfunction using advanced techniques such as tissue Doppler imaging and strain analysis. Diabetic patients are particularly prone to LVD due to chronic hyperglycemia, insulin resistance, and systemic inflammation, leading to myocardial fibrosis, microvascular dysfunction, and oxidative stress. This study evaluates the role of echocardiography in detecting subclinical and overt LVD in diabetic patients and explores associated clinical and biochemical risk factors.

METHODS

This observational cohort study included 500 diabetic patients aged 30-70 years, with the sample size determined using power calculation (95% confidence level, 5% margin of error). Stratified random sampling was used for participant selection, with hospital-based recruitment noted as a limitation. Patients underwent clinical evaluation, biochemical analysis, and echocardiographic assessment, including left ventricular ejection fraction (LVEF), diastolic function indicators, and LV mass index. Biochemical markers analyzed included fasting blood glucose, HbA1c, lipid profile, and high-sensitivity C-reactive protein (hs-CRP), which was selected for its strong association with cardiovascular risk and myocardial dysfunction. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States), applying descriptive statistics, correlation studies, and multivariate logistic regression, with adjustments for age, gender, BMI, hypertension, and diabetes duration.

RESULTS

Among the 500 participants, 140 (28%) exhibited diastolic dysfunction, while 90 (18%) had reduced LVEF (<50%), indicating diastolic dysfunction as the predominant abnormality. Patients with LVD had worse glycemic control and higher systemic inflammation markers than those with normal LV function. hs-CRP negatively correlated with the LVEF (r = -0.34, p = 0.022) and positively with the LV mass index (r = 0.38, p < 0.05), highlighting its role in myocardial remodeling. Multivariate analysis identified poor glycemic control and systemic inflammation as key predictors of LVD. Subgroup analysis showed that older patients (≥60 years) and those with diabetes duration >10 years had a higher prevalence of diastolic dysfunction and an increased LV mass index, suggesting progressive myocardial remodeling over time.

CONCLUSION

Echocardiography is a critical tool for early LVD detection, even in asymptomatic diabetic patients. Findings emphasize routine echocardiographic screening, particularly in those with diabetes duration ≥10 years, poor glycemic control (HbA1c >7%), or elevated hs-CRP levels, recommending assessments at least annually or sooner if symptoms arise. Managing glycemic and lipid profiles, alongside targeted inflammation-reducing strategies, such as anti-inflammatory pharmacologic interventions (e.g., statins, SGLT2 inhibitors, IL-6 inhibitors) and lifestyle modifications (diet, exercise, weight management), is essential for lowering cardiovascular risk. Integrating echocardiographic evaluation into routine diabetic care can help reduce the burden of diabetic cardiomyopathy and improve long-term cardiovascular outcomes.