Relation of retinopathy and microalbuminuria with diastolic dysfunction in subjects with type 2 diabetes mellitus

Abstract

Background: Prevalence of heart failure in asymptomatic type 2 DM subjects is increasing. Presence of microvascular complications like retinopathy and microalbuminuria, is under evaluation for predicting cardiovascular complications like heart failure in type 2 DM subjects. Aims and objectives: To study the relation between diabetic retinopathy and microalbuminuria with presence and grades of diastolic dysfunction in type 2 diabetes mellitus (DM) subjects. Materials and methods: This was a cross-sectional, observational study. A total of 62 subjects with type 2 diabetes mellitus (Type-2 DM) were enrolled. Fundoscopy examination for diabetic retinopathy, urine for microalbuminuria and standardized transthoracic echocardiographic (TTE) examination were performed. Left ventricular diastolic dysfunction (LVDD) was labeled if ≥3 of variables were present: "Septal e <7 cm/sec or Lateral e <10 cm/sec, E/e ratio >14, LA volume index >34 mL/m2, Peak TR velocity >2.8 m/sec. Results: The peak early trans-mitral filling wave velocity (E) was low in subjects with diabetic retinopathy [40 ± 11.6 cm/s vs 46 ± 9.6cm/s]. Mean of E/A ratio in subjects with diabetic retinopathy group was significantly lower compared to those without retinopathy ('p' < 0.03). The E/e' ratio was significantly higher in subjects with retinopathy (15.7 ± 2.48 vs 13.24 ± 1.88, p<0.02). The subjects with retinopathy and/or microalbuminuria had lower mean E/A ratio, deceleration time (DT), e' and higher E/e' ratio. Total 14(22.58%) subjects had diabetic retinopathy, all had mild non-proliferative diabetic retinopathy (NPDR) and 20(32.26%) subjects had microalbuminuria. Total 28 (45.16%) subjects had diastolic dysfunction [grade I: 24 (85.71%), grade-II: 4 (14.29%)]. Amongst 28 subjects with LVDD, 10(35.71%) had diabetic retinopathy and 15(53.57%) had microalbuminuria. Significant association was present between presence of retinopathy and microalbuminuria with diastolic dysfunction (p=0.024 and 0.001, respectively). Conclusion: Prevalence of LVDD in asymptomatic type 2 diabetes mellitus subject was 45.16%. Present study highlighted strong association between presence of diabetic retinopathy and microalbuminuria with LV diastolic dysfunction in subjects with type 2 diabetes mellitus.