Main Article Content

Misbah Manzoor
Bakht Babar


Objective: To find out and compare left ventricular diastolic dysfunction and its pattern among patients with type-2 diabetes mellitus (T2DM) with and without micro-albuminuria.

Methodology: This comparative cross section study was conducted in the outpatient department of Peshawar Institute of Cardiology from August 2021 to January 2022. A total of 228 T2DM normotensive patients, aged 30 to 65 years were enrolled and divided into two groups. Group-A contained 114 T2DM with no-albuminuria and Group-B had 114 T2DM micro-albuminuria patients. Socio-demographic, anthropometric, laboratory character­istics and echocardiographic parameters of all patients were noted. Qualitative variables were analyzed using chi-square test while quantitative variables were analyzed using t-test. P value <0.05 was considered statistically significant.

Results: Out of a total of 228 patients, 122 (53.5%) were male. Overall, mean age was noted to be 49.18+8.8 years. In comparison to group-A, duration of diabetes was significantly more among patients of group-B (p<0.001). Renal functions were significantly preserved in Group-A in comparison to Group-B (p=0.003) as shown by eGFR. Left ventricular diastolic dysfunction was found to be 49.1% among patients of Group-A in comparison to 71.1% in Group-B and pattern of left ventricular diastolic dysfunction showed a significant difference between patients of both study groups (0.004).

Conclusion: Left ventricular diastolic dysfunction was significantly high among T2DM patients with micro-albu­minuria. Significant associations were found in terms altered left ventricular diastolic echocardiographic features among T2DM patients with micro-albuminuria.

Article Details

How to Cite
Misbah Manzoor, Babar B. LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND ITS PATTERN IN TYPE 2 DIABETIC PATIENTS WITH AND WITHOUT MICROALBUMINURIA. J Postgrad Med Inst [Internet]. 2023 Mar. 1 [cited 2023 Jun. 1];37(1):36-40. Available from: https://www.jpmi.org.pk/index.php/jpmi/article/view/3074
Original Article


Athithan L, Gulsin GS, McCann GP, Levelt E. Diabetic cardiomyopathy: Pathophys¬iology, theories and evidence to date. World J Diabetes. 2019;10(10):490- 510. DOI:10.4239/wjd.v10.i10.490

Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular dis¬ease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovasc Diabetol. 2018;17(1):83. DOI:10.1186/s12933-018-0728-6

Yokota S, Tanaka H, Mochizuki Y, Soga F, Yamashita K, Tanaka Y, et al. Association of glycemic variability with left ventricu¬lar diastolic function in type 2 diabetes mellitus. Cardiovascular Diabetology. 2019;18:1-8. DOI:10.1186/s12933- 019-0971-5

Nikolajevic Starcevic J, Janic M, Sabo¬vic M. Molecular mechanisms responsi¬ble for diastolic dysfunction in diabetes mellitus patients. International journal of molecular sciences. 2019;20(5):1197. DOI:10.3390/ijms20051197

Grigorescu ED, Lacatusu CM, Floria M, Mihai BM, Cretu I, Sorodoc L. Left ventricular diastolic dysfunction in type 2 diabetes—progress and per¬spectives. Diagnostics. 2019;9(3):121. DOI:10.3390/diagnostics9030121.

Poirier P, Bogaty P, Garneau C, Marois L, Dumesnil JG. Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes. Importance of maneu¬vers in echocardiographic screening for preclinical diabetic cardiomyop¬athy. Diabetes Care 2001;24:5-10. DOI:10.2337/diacare.24.1.5

Nugroho BS, Rachman AM, Suryadipr¬adja RM, Waspadji S. Diastolic dysfunc¬tion in type 2 diabetes mellitus without cardiovascular abnormality. Indones J Intern Med. 2003;35:131-5.

Shogade TT, Essien IO, Ekrikpo UE, Umoh IO, Utin CT, Unadike BC, et al. Association of microalbuminuria with left ventricular dysfunction in Nigeri¬an normotensive type 2 diabetes pa¬tients. Cardiovasc J Afr. 2018 Sep/ Oct 23;29(5):283-288. DOI:10.5830/ CVJA-2018-026

Fangel MV, Nielsen PB, Kristensen JK, Larsen TB, Overvad TF, Lip GY, et al. Albuminuria and risk of cardiovascular events and mortality in a general pop¬ulation of patients with type 2 diabetes without cardiovascular disease: a Dan¬ish cohort study. The American Journal of Medicine. 2020;133(6):e269-79. DOI: 10.1016/j.amjmed.2019.10.042.

Nichols GA, Deruaz Luyet A, Hauske SJ, Brodovicz KG. The association be¬tween estimated glomerular filtration rate, albuminuria, and risk of cardio¬vascular hospitalizations and all-cause mortality among patients with type 2 diabetes. Journal of Diabetes and its Complications. 2018;32(3):291-7. DOI:10.1016/j.jdiacomp.2017.12.003

Hanna DB, Xu S, Melamed ML, Gon¬zalez F, Allison MA, Bilsker MS, et al. Association of Albuminuria With Cardiac Dysfunction in US Hispanics/Latinos. Am J Cardiol. 2017;119(12):2073-80. DOI:10.1016/j.amjcard.2017.03.039

Raja P, Maxwell AP, Brazil DP. The po¬tential of albuminuria as a biomarker of diabetic complications. Cardiovascular drugs and therapy. 2021;35:455-66. DOI:10.1007/s10557-020-07035-4.

Lin YC, Chang YH, Yang SY, Wu KD, Chu TS. Update of pathophysiology and man¬agement of diabetic kidney disease. J Formos Med Assoc. 2018;117(8):662- 75. DOI:10.1016/j.jfma.2018.02.007.

Varghese S, Kumar SG. Prevalence of micro albuminuria and diagnostic ac¬curacy of urine dipstick for the screen¬ing of diabetic nephropathy in type 2 diabetes patients. Biocatal Agric Bio¬technol. 2019;21(101316):101316. DOI:10.1016/j.bcab.2019.101316.

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for cham¬ber quantification. Eur J Echocardiogr. 2006;7(2):79-108. DOI:10.1016/j. euje.2005.12.014

Oh J, Park S, Nagueh S. Ad¬vances in cardiovascular imag¬ing: established and novel clinical applications of diastolic function as¬sessment by cardiography. Circ Imaging 2011;4(4):444–55. DOI:10.1161/CIR-CIMAGING.110.961623

Bouthoorn S, Valstar GB, Gohar A, den Ruijter HM, Reitsma HB, Hoes AW, et al. The prevalence of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction in men and women with type 2 diabetes: A systematic review and meta-analysis. Diab Vasc Dis Res. 2018;15(6):477-93. DOI:10.1177/1479164118787415.

Patil V, Patil H, Shah K, Vasani J, Shet¬ty P. Diastolic dysfunction in asymp¬tomatic type 2 diabetes mellitus with normal systolic function. Cardiovasc Dis Res. 2011;2(4):213–22. DOI 10.4103/0975-3583.89805.

Liu J, Robbins D, Palmieri V. Associa¬tion of albuminuria with systolic and diastolic left ventricular dysfunction in type 2 diabetes. J Am Coll Cardiol. 2003;41(11):202228. DOI:10.1016/ s0735-1097(03)00403-0.

Baykan M, Erdogan T, Erem C, Haciha¬sanoglu A, Gedikli O, Kucukosmano¬glu M, et al. The relationship between flow-mediated dilatation and left ven¬tricular function in type 2 diabetic pa¬tients with microalbuminuria. Endocrine. 2006;30(2):197-202. DOI:10.1385/ ENDO:30:2:197.

Mishra US, Soumya Ranjan P, Shrabani P. Evaluation of left ventricular function in type-2 diabetes mellitus with micro¬albuminuria. J Evid Based Med Healthc. 2020;7(8):385-89. DOI:10.18410/jeb-mh/2020/83.

Kuznetsova T, Thijs L, Knez J, Herbots L, Zhang Z, Staessen JA. Prognostic value of left ventricular diastolic dysfunction in a general population. J Am Heart Assoc. 2014;3(3):e000789. DOI:10.1161/ JAHA.114.000789.

Little WC, Oh JK. Echocardiographic evaluation of diastolic function can be used to guide clinical care. Circulation. 2009;120(9):802-9. DOI:10.1161/CIR¬CULATIONAHA.109.869602.

Aljaroudi W, Alraies MC, Halley C, Ro¬driguez L, Grimm RA, Thomas JD, et al. Impact of progression of diastolic dysfunction on mortality in patients with normal ejection fraction. Circulation. 2012;125(6):782-8. DOI:10.1161CIR¬CULATIONAHA.111.066423.