Cardiovascular Journal of Africa: Vol 29 No 5 (September/October 2018)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 5, September/October 2018

AFRICA

287

Liu

et al

was the first to report that albuminuria status was

independently associated with systolic and diastolic dysfunction

in patients with T2DM. Akiyama

et al

reported that the odds

of having LVDD in Japanese T2DM patients with albuminuria

was about eight times more than those without albuminuria (OR

7.95, 95%CI: 1.74–21.6,

0.005). By contrast, Alwis

et al

noted

in their study on 28 T2DM patients without any cardiovascular

disease that 73.7% of those without microalbuminuria and

66.7% of those with microalbuminuria had LVDD. Likewise,

Yildirimturk

et al

found among 50 diabetics, no significant

differences in LV systolic and diastolic function between patients

with or without MCA. The relatively smaller sample sizes may

explain the lack of significant difference in diastolic function

between diabetic patients with or without MCA in these studies.

In our study, the univariate model showed a strong direct

association of LVDD with microalbuminuria (OR 3.58, 95% CI:

1.99–6.82,

0.001) and age (OR 1.1, 95% CI: 1.04–1.17,

0.001), which is similar to a previous study.

Only age remained

as an independent predictor of LVDD (OR 1.10, 95% CI: 1.03–

1.17,

0.003) after controlling for other confounders, including

microalbuminuria.

It is commonly believed that grade 1 LVDD in patients above

65 years may represent a relaxation abnormality associated with

the aging process. However patients younger than 65 years may

represent impaired relaxation due to other conditions, which

may be a precursor to more advanced diastolic impairment if not

treated. In our study, subjects older than 65 years were excluded.

The negative prevalence of grade 2 and 3 LVDD in the control

group and the fact that pseudo-normal and restrictive LV filling

patterns are usually pathological phenomenona

suggest that

the higher proportion of LVDD seen in the diabetic groups was

linked not only to aging but also to DM with or without MCA.

We included both micro- and macroalbuminuric patients in

our study, as this increased the chances of detecting albuminuria

as an independent predictor of LVDD, as reported by Liu

in their study. Although the association between MCA

and LVDD in normotensive T2DM patients was weak, it was

stronger than the association of T2DM without albuminuria

with LVDD.

The limitation in this study was lack of glycated haemoglobin

values of the subjects studied.

Conclusion

Our study showed that the prevalence of LVDD was significantly

higher in normotensive T2DM patients with or without

microalbuminuria. This study was also confirmatory of the

strong direct association of microalbuminuria with LVDD and

the direct and independent association of age with LVDD in

normotensive diabetic patients. Therefore periodic screening for

microalbuminuria, especially in patients with risk factors such

as hypertension or diabetes, could allow early identification

of cardiovascular disease and help in stratifying overall

cardiovascular risk.

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