EVALUATION OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN TYPE II DIABETES MELLITUS – THE ROLE OF VALSALVA MANEUVER

BACKGROUND & OBJECTIVES: Left ventricular diastolic dysfunction is known to occur in early stages of diabetic cardiomyopathy but its exact prevalence is not known. The present study was conducted to assess the prevalence of diastolic dysfunction in diabetic patients in the absence of hypertension or CAD. The role of valsalva maneuver in diagnosis of diastolic dysfunction was also studied. AIMS: To study left ventricular diastolic dysfunction in asymptomatic normotensive patients with Type 2 Diabetes. To study the role of valsalva maneuver in diagnosing diastolic dysfunction. METHODOLOGY: 100 consecutive asymptomatic normotensive patients (mean age 52.34 ±8.6 yrs.) with Type 2 diabetes free of any major clinical diabetic complications and having no evidence of CAD on non-invasive testing were studied for LV diastolic functions, using pulsed Doppler at the tip of mitral valve. The peak velocities of LV filling during the early rapid (E wave) and atrial contraction (A wave) phases, the ratio of the 2 filling velocities (E/A ratio) were recorded at end expiration at baseline and again during phase II of valsalva maneuver. RESULTS: LVDD was found in 54% of subjects of whom 11% had pseudo normal pattern of ventricular filling and 43% had impaired relaxation. LVDD was well correlated with age and duration of diabetes. CONCLUSION: LVDD is much more common in Type 2 diabetes who are free of clinically detectable heart disease. Pseudonormal pattern may account for a significant number of patients with diastolic dysfunction and failure to recognize it may lead to significant underestimation of the true prevalence of LVDD in these patients.