Type 2 Diabetes causes Diastolic Dysfunction and Subclinical Left Ventricular Dysfunction over time
Nikhil Prasad Fact checked by:Thailand Medical News Team Jul 30, 2024 3 months, 3 weeks, 4 days, 18 hours, 7 minutes ago
Diabetes News: In a comprehensive seven-year study conducted by researchers from the National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, new insights into the cardiac risks associated with Type 2 Diabetes (T2D) have been revealed. This
Diabetes News report delves into the findings that link T2D to the progression of diastolic dysfunction and subclinical left ventricular dysfunction, even in the absence of overt cardiovascular disease.
Type 2 Diabetes causes Diastolic Dysfunction and Subclinical Left Ventricular Dysfunction over time
The Silent Threat
Heart failure is a well-known complication of diabetes, but what often goes unnoticed is diabetic cardiomyopathy (DCM), a condition characterized by structural and functional abnormalities in the heart muscle not directly related to other cardiovascular risk factors like hypertension or coronary artery disease. The term DCM remains a clinical concept, lacking a specific diagnostic code or universally accepted criteria, underscoring the need for further research to establish clear diagnostic parameters.
Study Overview
The study began in 2012-2013 with 120 participants aged 45 to 75 years, both with and without T2D. Over the course of the study, 57 participants completed the follow-up. The participants were divided into two groups: one with T2D and one without, serving as the control group. The study aimed to track long-term structural and functional changes in the heart's left ventricle (LV) using transthoracic two-dimensional echocardiography and other diagnostic tests.
Key Findings
Over the seven-year period, the study found significant changes in the T2D group:
-Diastolic Dysfunction (DD): The prevalence of DD increased from 53% to 61% in the T2D group, a statistically significant change. No such increase was observed in the control group.
-Global Longitudinal Strain (GLS): The proportion of patients with reduced GLS (an indicator of systolic function) increased in the T2D group, highlighting a decline in the heart's ability to contract effectively.
-Structural Changes: Significant increases were observed in the thickness of the interventricular septum and the posterior wall of the LV, as well as in relative wall thickness, indicating concentric hypertrophy - a condition where the walls of the heart thicken but the size of the chamber remains the same.
Clinical Implications
The study underscores T2D as an independent risk factor for worsening subclinical LV dysfunction over time. This finding is critical as it highlights the importance of regular cardiac monitoring in patients with T2D, even in the absence of clinical symptoms of heart disease. The use of advanced echocardiographic techniques like speckle-tracking echocardiography (ST
E) to measure GLS provides a more sensitive method for detecting early cardiac dysfunction.
Risk Factors and Predictors
Multivariate analysis identified several independent predictors for the development of diastolic dysfunction and reduced GLS in patients with T2D:
-Carbohydrate Metabolism Disorders: Elevated fasting glucose levels, glycated hemoglobin (HbA1c), and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index were significant predictors.
-Inflammation: High-sensitivity C-reactive protein (hsCRP) levels also emerged as a significant predictor, emphasizing the role of inflammation in the progression of diabetic cardiomyopathy.
The Role of Biomarkers
The study also examined the role of biomarkers like NT-proBNP in diagnosing subclinical LV dysfunction. While NT-proBNP levels did increase significantly in the T2D group, they remained within normal limits, indicating that while useful, NT-proBNP alone may not be sufficient for early diagnosis of DCM. This finding aligns with other research suggesting that low levels of NT-proBNP can still correlate with significant structural and functional heart changes in T2D patients.
Conclusion
The findings from this study provide crucial evidence that T2D significantly contributes to the progression of subclinical left ventricular dysfunction, manifesting as diastolic and systolic dysfunction over time. This underscores the importance of comprehensive cardiac monitoring and management in T2D patients to prevent the transition from subclinical to overt heart failure.
The study's results were published in the on a preprint server and are currently being peer reviewed.
https://www.preprints.org/manuscript/202407.2329/v1
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