Study of Microalbuminuria in Type 2 Diabetes Mellitus as a Predictor of Left Ventricular Dysfunction- A Cohort Study

Abstract

Introduction: Diabetes Mellitus (DM) is a global health problem and India is the capital of it. It leads to acute metabolic and long-term complications with high morbidity and mortality. Cardiovascular (CV) disease is the major cause of mortality. Microalbuminuria (MAU) has been associated with generalised vasculopathy in major organ systems. Left Ventricular (LV) dysfunction and premature onset of CV disease is predicted by MAU. Aim: To evaluate the correlation of degree of microalbuminuria in Type 2 Diabetes Mellitus (Type2DM) as a predictor of LV dysfunction. Materials and Methods: This was a cohort study conducted in the Outpatient Department (OPD) of Medicine on 251 patients clinically diagnosed with Type2DM. Subjects were selected as per American Diabetic Association (ADA) criteria and cases having hypertension Ischaemic Heart Disease (IHD), valvular heart disease, Chronic Kidney Disease (CKD), Urinary Tract Infection (UTI), Chronic Liver Disease (CLD) were excluded from the study. MAU was assessed as having persistent albuminuria in two out of three urine samples as (30-300 mg/day or 20- 200 microgram per mg or an albumin creatinine ratio of 30- 300 microgram per mg creatinine). Echocardiogram to assess LV function were done in the Department of Cardiology using dual mode real time, 213/M-Mode, colour doppler, pulsed web doppler, continuous web doppler, considering criteria of American Society of Echocardiography and Mayo Clinic criteria. Data was analysed by Unpaired t-test for normal data, Chisquare test for dichotomous data and values were correlated using Pearson’s correlation coefficient. Results: Out of 251 study subjects, 148 were males and 103 were females with male to female ratio of 1.43:1. MAU was positive in 24.7% cases out of 251 cases. Echocardiogram revealed 77.4%% of study population have LV dysfunction and 46.8% of cases having diastolic dysfunction. With increased level of MAU, the incidence of LV diastolic dysfunction and LV systolic dysfunction also increased. In LV systolic dysfunction, severity of MAU was negatively correlated with Ejection fraction (EF), Fractional Shortening (FS), Cardiac Output (CO) and positively correlated with E Point Septal Separation (EPSS). In LV diastolic dysfunction, all parameters were positively correlated with severity of MAU. Severity of MAU and LV dysfunction were correlated and was found statistically significant (p<0.05). Conclusion: Severity of MAU was found to have significant correlation with parameters of LV systolic and diastolic function with significant p-value. LV dysfunction has also a strong correlation with poor glycaemic control and duration of DM.

Keywords

• cardiovascular disease
• echocardiography
• ejection fraction
• glycaemic control
• isovolumic relaxation time
• left ventricular internal diameter