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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 5, September/October 2018
AFRICA
283
Association of microalbuminuria with left ventricular
dysfunction in Nigerian normotensive type 2 diabetes
patients
TT Shogade, IO Essien, UE Ekrikpo, IO Umoh, CT Utin, BC Unadike, JJ Andy
Abstract
Background:
Diabetes mellitus (DM) is a risk factor for
left ventricular (LV) dysfunction, and microalbuminuria is
frequently associated with DM. This study aimed to compare
LV function among normotensive type 2 diabetes (T2DM)
patients with normoalbuminuria, those with microalbuminu-
ria, and healthy controls.
Methods:
This was a cross-sectional study conducted at the
diabetes and cardiology clinics of the University of Uyo
Teaching Hospital, Uyo, Akwa-Ibom State, Nigeria, from
January 2013 to March 2014. Microalbuminuria was tested for
using Micral test strips, and echocardiography-derived indices
of LV function were compared among the three groups.
Results:
Sixty-three normoalbuminuric, 71 microalbuminuric
T2DM patients and 59 healthy controls were recruited. Mean
age of participants was 50
±
8 years and the three groups were
age and gender matched (
p
=
0.23,
p
=
0.36, respectively). LV
diastolic dysfunction (LVDD) showed a stepwise increase
from the healthy controls to the normoalbuminuric to the
microalbuminuric T2DM patients (16.9 vs 61.9 vs 78.9%,
respectively) (
p
<
0.001), while E/A ratio and fractional
shortening showed a significant stepwise decrease (both
p
<
0.001). LV systolic dysfunction was rare among the three
groups. Microalbuminuria showed a strong direct association
with LVDD (OR 3.58, 95% CI: 1.99–6.82,
p
<
0.001). Age
remained independently associated with LVDD (OR 1.10,
95% CI: 1.03–1.17,
p
=
0.003).
Conclusions:
LV diastolic function was altered in Nigerian
normotensive T2DM patients, and the presence of microalbu-
minuria with DM had additional effects on this abnormality.
Early screening for DM and microalbuminuria could identify
individuals with high cardiovascular risk and possibly abnor-
mal LV function.
Keywords:
diabetes mellitus, microalbuminuria, left ventricle,
diastolic dysfunction
Submitted 19/2/17, accepted 10/4/18
Published online 13/6/18
Cardiovasc J Afr
2018;
29
: 283–288
www.cvja.co.zaDOI: 10.5830/CVJA-2018-026
Diabetes mellitus (DM) is associated with diverse cardiovascular
conditions such as myocardial infarction, heart failure (HF),
stroke and diabetic cardiomyopathy (DMCMP), which are the
leading causes of diabetes-related morbidity and mortality.
1,2
Previous studies elsewhere
3,4
and in Nigeria
5
have demonstrated
left ventricular diastolic dysfunction (LVDD) in normotensive
diabetics, supporting the existence of DMCMP.
The Framingham Heart Study showed that the frequency
of HF is twice as high in diabetic men and five times higher in
diabetic women compared with age-matched controls, and that
this increased incidence of HF persisted despite correction for
age, hypertension, obesity, hypercholesterolaemia and coronary
artery disease (CAD).
6
An increased risk for developing HF in
prospective analyses after correction for confounding variables
has also been reported.
7
Therefore screening for the presence
of DMCMP at the earliest stage is appropriate for the early
detection and prevention of HF.
The most sensitive non-invasive test for detection of LV
dysfunction is a two-dimensional echocardiogram with pulsed-
wave Doppler.
8
As the cost of echocardiography is high, a less
expensive pre-screening test for monitoring further deterioration
in cardiac function in normotensive type 2 diabetes (T2DM)
patients is needed. Microalbuminuria (MCA), a known marker
of glomerular endothelial dysfunction, is also associated with
microangiopathy in T2DM patients.
9
It is suggested here that
detection of MCAmay also serve as an inexpensive pre-screening
test for monitoring further deterioration in cardiac function in
normotensive T2DM Nigerian patients. This study was designed
to determine whether the presence of MCA in T2DM Nigerian
subjects could demonstrate further deterioration in cardiac
function in these patients.
Methods
The study was done in accordance with the Declaration of Helsinki
and the protocol was approved by the University of Uyo Teaching
Hospital, Uyo Institutional Health Ethical Research Committee
(IHREC) reference number UUTH/AD/S/96/VOL.XII/38. The
study was conducted in the diabetes and cardiology clinics of
UUTH between January 2013 and March 2014. Two hundred
participants were recruited; 134 consecutive diabetic patients,
diagnosed according to the American Diabetes Association,
10
or
who were on oral antidiabetic drugs, and 59 non-diabetic age- and
gender-matched controls completed the study.
Department of Medicine, College of Health Sciences,
University of Uyo, and University of Uyo Teaching Hospital,
Uyo, Akwa-Ibom, Nigeria
TT Shogade,MB ChB, FMCP (Cardiol),
docttaiwo@yahoo.comIO Essien, MB BCh, FMCP (Cardiol)
UE Ekrikpo,MB BS, MSc (Med) (Epidemiology & Biostat), FMCP
(Nephrol)
IO Umoh, MB BCh, FWACP (Cardiol)
BC Unadike, MB BS, FMCP (Endo) (deceased)
JJ Andy, MB BS, FWACP, FMCP
Cleno Health Ultrasound Institute, Uyo, and University of
Uyo Teaching Hospital, Akwa-Ibom, Nigeria
CT Utin,MBA, DCR, RDMS, RDCS