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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
64
VOLUME 15 NUMBER 2 • NOVEMBER 2018
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
Correspondence to: TT Shogade
Department of Medicine, College of Health Sciences, University of Uyo, and
University of Uyo Teaching Hospital, Uyo, Akwa-Ibom, Nigeria
e-mail:
docttaiwo@yahoo.comIO Essien, UE Ekrikpo, IO Umoh, BC Unadike (deceased), JJ Andy
Department of Medicine, College of Health Sciences, University of Uyo, and
University of Uyo Teaching Hospital, Uyo, Akwa-Ibom, Nigeria
CT Utin
Cleno Health Ultrasound Institute, Uyo, and University of Uyo Teaching
Hospital, Akwa-Ibom, Nigeria
Previously published in
Cardiovasc J Afr
2018;
29
(5): 283–288
S Afr J Diabetes Vasc Dis
2018;
15
: 64–68
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 micro-
albuminuria, 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 participantswas 50 ± 8 years and the three groupswere
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
microalbuminuria with DM had additional effects on this
abnormality. Early screening for DM and microalbuminuria
could identify individuals with high cardiovascular risk and
possibly abnormal LV function.
Keywords:
diabetes mellitus, microalbuminuria, left ventricle,
diastolic dysfunction
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-relatedmorbidity andmortality.
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 pulsedwave
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 MCA may
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