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

Abstract

Objective: Existing data showed that left ventricular diastolic dysfunction is common in individuals with type 2 diabetes mellitus (T2DM). 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 T2DM without prior cardiovascular disease using the latest recommended echocardiographic assessment for left ventricular diastolic dysfunction.Design and Participants: This is a cross-sectional study in which eligible patients with T2DM 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 was sent to test for B-type natriuretic peptide, and transthoracic echocardiography was performed to assess left ventricular dysfunction.Setting: This study was performed in a tertiary healthcare center located in Kuala Lumpur, Malaysia.Results: Of the 301 patients, 83.1% have had T2DM for >10 years, with 45.8% being poorly controlled. Comorbidities include hypertension (77.1%), hyperlipidemia (91.0%), and pre-obesity/obesity (72.9%). Majority had absence of microvascular (albuminuria, retinopathy, and neuropathy) and macrovascular (peripheral vascular disease and stroke) complications. None had raised B-type natriuretic peptide levels, 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 more likely to develop left ventricular diastolic dysfunction.Conclusion: There was a high prevalence of asymptomatic left ventricular diastolic dysfunction among patients with T2DM without prior known cardiovascular disease. Older age, insulin therapy, and Chinese ethnicity were risk factors for left ventricular diastolic dysfunction in T2DM.

Ethnic disparities and its association between epicardial adipose tissue thickness and cardiometabolic parameters

“…Contrary to our findings, the recent National Health and Morbidity Survey 2019 indicates that abdominal adiposity is highest among Indians. However, the current findings are in agreement with another Malaysian study, whereby Chinese ethnicity was regarded as one of the risk factors for left ventricular diastolic dysfunction in T2DM in Malaysian populations [ 34 ]. It is known that EAT is associated with impaired left ventricular (LV) function, even if cardiovascular disease is absent [ 35 ].…”

Effects of Incretin-Based Treatment on the Diastolic (Dys)Function in Patients with Uncontrolled Type 2 Diabetes Mellitus: A Prospective Study with 1-Year Follow-Up

“…The assessment of diastolic (dys)function in the present research was performed according to the algorithm for diagnosing diastolic dysfunction in patients with normal EF. At baseline, the prevalence of grade 1 diastolic dysfunction was approximately 50%, which is within the range of values reported in the literature in populations without known CVD [54][55][56][57].…”

Characterization of left ventricular diastolic parameters of gated-single-photon emission computed tomography myocardial perfusion imaging in patients with diabetes and normal myocardial perfusion and systolic function

“…Unlike LV systolic dysfunction, diastolic dysfunction is often not diagnosed in most patients. Diastolic dysfunction itself is associated with a poor prognosis, can progress to systolic dysfunction, and is thought to exist in patients with diabetes before the onset of heart failure with reduced ejection fraction [11]. Ongoing investigations on the pathophysiology of diabetic cardiomyopathy are still taking place, although various mechanisms have been suggested.…”