AUTHOR=Chee Kok Han , Tan Kok Leng , Luqman Ibrahim , Saiful Shahrizal Shudim , Chew Yee Yean , Chinna Karuthan , Tan Alexander Tong Boon 

TITLE=Prevalence and Predictors of Left Ventricular Diastolic Dysfunction in Malaysian Patients With Type 2 Diabetes Mellitus Without Prior Known Cardiovascular Disease

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.676862

DOI=10.3389/fcvm.2021.676862

ISSN=2297-055X

ABSTRACT=Objective: Existing data showed left ventricular diastolic dysfunction are common in individuals with type 2 diabetes mellitus. However, most of the studies included diabetic patients who have prior cardiovascular disease which might be the compounding factor for ventricular dysfunction. This study aimed to determine the prevalence and predictors of left ventricular diastolic dysfunction in an Asian population with type 2 diabetes mellitus without prior cardiovascular disease using the latest recommended echocardiographic assessment for left ventricular diastolic dysfunction.
Design and Participants: A cross-sectional study in which eligible patients with type 2 diabetes mellitus without history of coronary artery disease, heart failure or valvular heart disease were recruited. Demographic data, diabetic control, comorbidities, microvascular/macrovascular complications, and medications prescribed were recorded. Venous blood sent for B-type natriuretic peptide and transthoracic echocardiography was performed to assess left ventricular dysfunction.
Setting: Tertiary healthcare center located at Kuala Lumpur, Malaysia
Results: Of the 301 patients, 83.1% had type 2 diabetes mellitus of >10 years with 45.8% being poorly controlled. Comorbidities include hypertension (77.1%), hyperlipidemia (91.0%) and pre-obese/obese (72.9%). Majority absence of microvascular (albuminuria, retinopathy, neuropathy) and macrovascular (peripheral vascular disease, stroke) complications. None had raised B-type natriuretic peptide and 93.7% had no symptoms of heart failure. On echocardiographic assessment, 70.1% had left ventricular diastolic dysfunction and 90.5% had Grade 1/mild severity. Age, ethnicity, insulin therapy, presence of hypertension and hyperlipidemia were significantly associated with left ventricular diastolic dysfunction. Older T2DM patients of Chinese ethnicity and on insulin are about two times likely to develop left ventricular diastolic dysfunction.
Conclusion: There was a high prevalence of asymptomatic left ventricular diastolic dysfunction among patients with type 2 diabetes mellitus without prior known cardiovascular disease. Older age, insulin therapy and Chinese ethnicity were risk factors for left ventricular diastolic dysfunction in T2DM.