The SA Journal Diabetes & Vascular Disease Vol 15 No 2 (November 2018)

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RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE
68 VOLUME 15 NUMBER 2 • NOVEMBER 2018
and IVRT in the microalbuminuric than the normoalbuminuric
group.
Liu et al .18 was the first to report that albuminuria status was
independently associated with systolic and diastolic dysfunction
in patients with T2DM. Akiyama et al.23 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, p = 0.005). By contrast, Alwis et al.4 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.24 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, p < 0.001) and age (OR 1.1, 95% CI: 1.04–1.17, p <
0.001), which is similar to a previous study.22 Only age remained
as an independent predictor of LVDD (OR 1.10, 95% CI: 1.03–
1.17, p < 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 phenomenona25 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 et al.18 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
OurstudyshowedthattheprevalenceofLVDDwassignificantlyhigher
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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