Evaluation of cardiac functions with Tissue Doppler Imaging Method in prediabetic subjects.

Diabetes Mellitus (DM) is one of the most common diseases throughout the world. The incidence of disease has been increasing rapidly. By the year 2025, it has been estimated that DM incidence will rise up to 5,4% and the number of diabetic patients will exceed 300 millions worldwide. The increase has been estimated to be 42% in the developed countries and 170% in developing countries 1. American Diabetes Association (ADA) and World Health Oganization (WHO) have revised diagnostic criteria in order to make early diagnosis 2. The terms of Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) have been included in the literature. These two terms describe the process so-called ?pre-diabetic period? 3-4.Diabetic cardiomyopathy can be described as the abnormality of myocardial performance or structure in diabetic patients without hypertension, CAD and serious valve disease. Factors that play role in development of disease are; increment of connective tissue and stiffness in left ventricule wall as a result of accumulation of insoluble collagen 17-18, impaired autonomic function 19, endothelial disfunction, deformation in various ligand (ß-agonists) sensivity 20 and abnormalities of proteins which arrange ion flow mainly calcium 21,22 . Diabetic cardiomyopathy was ? rst reported in 1972 by Rubler et al, who reported the autopsy data from 4 patients with diabetic renal microangiopathy and dilated left ventricles in the absence of other common causes 23. The pathophysology of this clinical entity remains elusive despite despite more than 3.5 decades of basic and clinical investigations 24. Furthermore, worsening glycemic control can compound this risk, and the concomitant diagnoses of diabetes and heart failure may indicate a poor prognosis 5. There are mainly three clinicopathologic features in diabetic cardiomyopathy; diastolic dysfunction 46,54,55 systolic disfunction 68,70 and structural changes of myocardium.In our study, we aimed to evaluate prediabetic patients by tissue doppler who have normal cardiac functions clinically and normal conventional echocardiographic findings. We examined 60 patients (30 female, 30 male) and 20 healthy control group (10 male,10 female). The patiens were divided into three groups according to their fasting plasma glucose and second-hour glucose values in 75 gr OGTT. The healthy control group consisted of 20 patients and was categorized as the fourth group. There was no signi ? cant difference between there groups (group 1, group 2, group 3, group 4) and controls with respect to age, gender, weight, systolic/diastolic blood pressure and heart rate. The findings of conventional echocardiography and tissue doppler imaging findings are summarized in Table 4. No significant difference was found among groups in terms of conventional echocardiographic findings. While there was no significant difference (11,65 ± 0,66 vs 72±1,58 p = 0,084) between controls and group 1 with respect to early peak diastolic velocity (Ea) of medial mitral annulus, a statistically significant difference was found between controls and group 2 (9,06 ± 1,07 p= <0,001) and group 3 (9,74 ± 1,09 p= 0,008). Although the ratio of early peak diastolic velocity to late peak diastolic velocity (Ea/Aa) was statistically similar between controls and group 3 (1,35 ± 0,11 vs 1,02 ± 0,24 p= 0,065), a statisticly significant lower ratio was found in group 1 and group 2 ( 1,35 ± 0,11 vs 0,99±0,22 p = 0,038) (1,35 ± 0,11 vs 0,93±0,19 p= 0,012). However no significant differences were found among groups both in measurements performed from lateral of mitral annulus (SlatA, ElatA, AlatA) and in lateral myocard measurements (SlatM, ElatM, AlatM).As a result, although regional and global systolic/diastolic flow velocities obtained with Pulse-wave TDI show significant difference from beat to beat at the same area, it is a feasible method in evaluating systolic and diastolic functions of the left ventricule. However standards should be defined in recognizing pathologic conditions by performing studies in various patient groups and wide-series.