Left Ventricular Diastolic Dysfunction (LVDD) Whether more in Hypertension or Diabetes Mellitus? An Echocardiographic Study
Background: To assess the effect of Hypertension and Diabetes on Left Ventricular Diastolic Function. Methods: 2D Echocardiography was performed in 295 subjects. Subjects were divided into two groups – Group 1 having hypertension (HTN) and Group 2 having diabetes mellitus only (DM). Patients with cardiac illness like heart failure, myocardial infarction, arrhythmias were excluded from the study. The procedure was explained and consent was obtained from the patients. All the subjects underwent detail clinical examination. Height, weight, blood pressure, blood sugar, lipid profile, ECG was done. Early peak Diastolic (E) and late peak diastolic (A) transmitral flow were recorded. E/A was calculated. Data are presented as Mean ± Standard Deviation for continuous variables and as proportions for categorical variables. The X2 test was used to test differences between proportion. Multiple linear regressions were performed to assess the independent association of hypertension and diabetes with Diastolic function parameters. Differences between Hypertension and Diabetes group were assessed by one way analysis of variance. (Performed using STATA). Results: Correlation of hypertension and diabetes with Diastolic function parameters. Diabetes subjects had significantly higher A wave (P<0.05) and lower E/A ratio. No significant differences were observed between hypertension and diabetes groups in any of the Diastolic function parameters. Conclusions: Prevalence of Diastolic dysfunction of any grade in both subjects were 58.2% (62.2in Hypertension and 54.3% in Diabetes).
2. Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. J Am Med Assoc 2003;289: 194–202.
3. Garcia MJ, McNamara PM, Gordon T, Kannel WB. Morbidity and mortality in diabetics in the Framingham population. Sixteen-year follow-up study. Diabetes 1974;23:105–111.
4. Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 1974;34:29–34.
5. Gottdiener JS, Arnold AM, Aurigemma GP, Polak JF, Tracy RP, Kitzman DW,Gardin JM, Rutledge JE, Boineau RC. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol 2000;35:1628–1637.
6. Zabalgoitia M, Ismaeil MF, Anderson L, Maklady FA. Prevalence of diastolic dysfunction in normotensive, asymptomatic patients with well-controlled type 2 diabetesmellitus. Am J Cardiol 2001;87:320–323.
7. Palmieri V, Bella JN, Arnett DK, Liu JE, Oberman A, Schuck MY, Kitzman DW on left ventricular geometry and systolic function in hypertensive subjects: Hypertension Genetic Epidemiology Network (HyperGEN) Study. Circulation 2001;103:102–107.
8. Poirier P, Bogaty P, Garneau C, Marois L, Dumesnil JG. Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes: importance of maneuversin echocardiographic screening for preclinical diabetic cardiomyopathy. Diabetes Care 2001;24:5–10.
9. Di Bonito P, Moio N, Cavuto L, Covino G, Murena E, Scilla C, Turco S, Capaldo B, Sibilio G. Early detection of diabetic cardiomyopathy: usefulness of tissue Doppler imaging. Diabet Med 2005;22:1720–1725.
10. Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, Lee MM, Park YB, Choi YS, Seo JD, Lee YW. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997;30:474–480.
11. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous
Doppler-catheterization study. Circulation 2000;102:1788–1794.
12. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009;22:107–133.
13. Fox ER, Han H, Taylor HA, Walls UC, Samdarshi T, Skelton TN, Pan J, Arnett D.The prognostic value of the mitral diastolic filling velocity ratio for all-cause mortality and cardiovascular morbidity in African Americans: the Atherosclerotic Risks in Communities (ARIC) study. Am Heart J 2006;152:749–755.
14. Fang ZY, Yuda S, Anderson V, Short L, Case C, Marwick TH. Echocardiographic detection of early diabetic myocardial disease. J Am Coll Cardiol 2003;41:611–617.
15. Wachter R, Luers C, Kleta S, Griebel K, Herrmann-Lingen C, Binder L, Janicke N, Wetzel D, Kochen MM, Pieske B. Impact of diabetes on left ventricular diastolic function in patients with arterial hypertension. Eur J Heart Fail 2007;9:469–476.
16. Nishimura RA, Tajik AJ. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta Stone. J Am Coll Cardiol 1997;30:8–18.
17. Oh JK, Appleton CP, Hatle LK, Nishimura RA, Seward JB, Tajik AJ. The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 1997;10:246–270.
18. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 1997;30:1527–1533.
19. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–458. doi: 10.1016/0002-9149(86)90771-X.