Changes in left ventricular structure and function in Type 2 diabetic patients, depending on the presence of cardiac autonomic neuropathy and metabolic syndrome components

Abstract

Aim. To assess the impact of cardiac autonomic neuropathy (CAP) on left ventricular (LV) structure and function in patients with Type 2 diabetes mellitus (DM-2), depending on the presence of metabolic syndrome (MS) components. Material and methods. The study included 157 patients (128 women and 29 men) with DM-2. MS was diagnosed according to WHO criteria. CAN was detected based on the standard Ewing test (≥2 positive results). M-mode, B-mode, and Doppler echocardiography was performed in 4 clinical groups: Group I (n=14): CAN-negative, ≤1 MS component; Group II (n=16): CAN-negative, ≥2 MS components; Group III (n=19): CAN-positive, ≤1 MS component; and Group IV (n=108): CAN-positive, ≥2 MS components. LV geometry type, as well as LV systolic and diastolic function, was assessed according to the standard criteria. Results. LV concentric hypertrophy (LVCH) was the most prevalent type of LV geometry in CAN-positive vs. CAN-negative patients (62,2% vs. 20,0%, respectively; p=0,02). The highest LVCH prevalence (63,9%) was registered in participants with CAN and ≥2 MS components. Over 50% of the patients with 0–1 MS component and two-thirds of the patients with ≥2 MS components had disturbed LV diastolic function. In the former, CAN presence did not affect the prevalence of diastolic dysfunction, while in the latter, diastolic dysfunction was significantly more prevalent among CAN-positive individuals (90,7%, compared to 56,2% in CAN-negative patients with ≥2 MS components; p=0,001). Conclusion. In DM-2 patients, CAN was associated with LVCH andLV diastolic dysfunction. This association strengthened, as the number of MS components increased.

Keywords

• type 2 diabetes mellitus
• cardiac autonomic neuropathy
• metabolic syndrome
• echocardiography