Determinants of Left Ventricular Diastolic Dysfunction in Normotensive Patients With Type 2 Diabetes Mellitus: A Tertiary Hospital-Based Study in Ghana

TL;DR

This study found that mild heart function issues are common in normotensive type 2 diabetes patients in Ghana, linked to age, heart rate, and heart structure changes.

Contribution

The study provides new insights into LVDD prevalence and its determinants in normotensive T2DM patients in Ghana.

Findings

42.7% of normotensive T2DM patients showed evidence of LVDD, mostly mild.

Older age, higher heart rate, and increased septal wall thickness were independently associated with LVDD.

LVDD was more common in symptomatic participants.

Abstract

Background

Diabetes mellitus is a growing global health challenge, with significant cardiovascular complications among affected populations. Left ventricular diastolic dysfunction (LVDD) represents an early manifestation of diabetic cardiomyopathy and predicts adverse outcomes. Data on LVDD in normotensive patients with type 2 diabetes mellitus (T2DM) in Ghana are limited. This study aimed to estimate the prevalence and identify determinants of LVDD among normotensive T2DM patients presenting to the Korle-Bu Teaching Hospital in Ghana.

Methodology

This was a descriptive cross-sectional study of randomly selected normotensive T2DM patients attending the National Diabetes Management and Research Centre at the Korle-Bu Teaching Hospital between January 2016 and December 2016. Transthoracic echocardiography was performed, and left ventricular diastolic function was assessed and graded based on pulsed Doppler of the mitral inflow velocities and tissue Doppler imaging of the mitral annuli.

Results

Three hundred and sixty-five participants were recruited, of whom 254 (69.6%) were female. The mean age of the participants was 50.7 ± 8.2 years. Of the 365 participants enrolled, 356 (97.5%) had complete echocardiographic data; nine participants with inconclusive findings were excluded from the analysis. One hundred and fifty-two participants (42.7%, 95%CI 37.5%-47.9%) had evidence of LVDD, comprising mostly grade 1 LVDD (96.1%). Older age (aOR 1.160, 95%CI 1.108-1.214, p<0.001), increased septal wall thickness (aOR 7.628, 95%CI 1.160-50.176, p=0.035), and a higher heart rate (aOR 1.037, 95%CI 1.007-1.067, p=0.016) were independently associated with the presence of LVDD. Participants with LVDD were more likely to be symptomatic.

Conclusion

Mild LVDD was common among normotensive Ghanaian patients with T2DM, with age, heart rate, and cardiac remodeling associated with its presence. These findings underscore the potential value of echocardiographic screening in this population, while longitudinal studies are needed to establish prognostic significance.