Microalbuminuria as an early marker of left ventricular hypertrophy in type 2 diabetes mellitus

Abstract

Background: Microalbuminuria and left ventricular hypertrophy (LVH) have both been shown independently to be associated with increased cardiovascular (CVS) mortality in type 2 diabetes mellitus (DM) patients. This cross-sectional study was conducted to examine whether microalbuminuria is associated with LVH in non-hypertensive type 2 DM patients with early or no diabetic nephropathy.Methods: 100 patients of type 2 DM were studied. Patients with Hypertension (BP >140/90 mm hg or on anti-hypertensive medication), history of coronary artery disease or valvular heart disease, estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, known thyroid disease or active urinary tract infection (UTI) were excluded from the study. All patients were subjected to spot urine test for microalbuminuria by urinary albumin creatinine ratio (UACR), 12 lead ECG to detect LVH, 2D echocardiography to calculate LV mass index (LVMI), anthropometry, urine routine examination, kidney function test, fasting lipid profile and HbA1c.Results: Of the 100 enrolled patients, 39 were found to have normoalbuminuria, 39 had microalbuminuria & 22 patients had macroalbuminuria. The correlation between increased albuminuria and LVMI was found to be statistically significant (P value < 0.001) and the LV mass significantly increased as albuminuria increased along the continuum of normoalbuminuria to macroalbuminuria. UACR showed a statistically significant correlation with age, eGFR, duration of diabetes (P value < 0.01) and HbA1c (P value < 0.05).Conclusions: Microalbuminuria is associated with LVH in non-hypertensive type 2 DM patients and thus may serve as an early marker of LVH and help identify patients at high CVS risk.

Association of microalbuminuria with left ventricular dysfunction in type 2 diabetes mellitus

“…In the present study, the mean fasting blood sugar (FBS), post-prandial blood sugar (PPBS), and HbA1c level was significantly lower in normoalbuminuric group compared to microalbuminuric group. This finding is concordant to the study by Kanwar BS et al [11].…”

“…Echocardiography parameters like left ventricular internal dimension in systole (LVIDs), left ventricular endsystolic volume (LVESV), ejection fraction, deceleration time (DT), and acceleration time (AT) were comparable between the groups in our study. This is in concordance to the studies of Kanwar BS et al, Shogade TT et al, and Swoboda PP et al [11,12,19].…”

“…There was significant difference in mean duration of diabetes between microalbuminuric and normoalbuminuric groups in our study, which is comparable to the studies of Kanwar BS et al and Shogade TT et al [11,12].…”

“…Our patients in the study were predominantly from the age group of 51-60 years and the difference in gender distribution of patients between the two groups was insignificant. This patient profile in our study is similar to [11][12][13][14].…”

Association of Microalbuminuria with Abnormal Left Ventricular Geometry Patterns in Nigerian Normotensive Type 2 Diabetic Patients

“…Kanwar et al in their crossectional study done on 100 normotensive Indians with diabetes mellitus reported that the correlation between increased albuminuria and LVMI was found to be statistically significant (P value < 0.001) and the LV mass significantly increased as albuminuria increased along the continuum of normoalbuminuria to macroalbuminuria [30]. In our study, which is the first of its kind in Africa, we found that persistent microalbuminuria has a strong association with LV geometry remodeling, that microalbuminuric normotensive diabetics are three times more likely to have LV geometry remodeling than normoalbuminuric group.…”