Systematic echo-doppler screening identifies subtle structural and functional cardiac abnormalities in type 2 diabetes mellitus without documented cardio vascular disease: DIACAR a prospective study

Background Type 2 diabetes mellitus (DM2) is associated with a high prevalence of cardio vascular (CV) disorders including heart failure. The prevalence of asymptomatic cardiac dysfunction in DM2 remains poorly documented in patients without a history of cardio vascular disease. The purpose of DIACAR is to characterize cardiac function by doppler-echocardiography in a population of DM2 without documented CV disease. Methods One hundred and sixteen consecutive outpatients (63 males, 53 females) with DM2 were evaluated prospectively in a single center: 2D (Simpson biplane) & 3D (Heart Model Philips) left ventricular (LV) ejection fraction (EF), LV and left atrial (LA) volumes, 2D global longitudinal strain, diastolic function and LV mass index were measured. All patients with a documented history of CV disease or presenting with symptoms suggestive of any cardiac disorder were excluded. Results Patients were 57.8 ± 10.9 years old and had a history of DM2 of 12.7 ± 8.7 years. Fifty-two patients (45%) were treated with insulin. Body mass index was 29 ± 4.9 kg/m2. Mean values of the echo Doppler parameters were in the normal range ( Table 1 ). 2D Simpson EF and E/e’ were normal in all except one and two patients respectively. However, LV mass index was increased in 8/63 men and 10/53 women and LA volume index was increased in 14/116 patients whereas 2D Simpson LV volumes were all in the normal range. Finally, 2D global longitudinal strain was reduced in 44/105 patients. Conclusion In a selected population of DM2 without documented CV disease, cardiac function assessed by EF and E/e’ was in the normal range in nearly all patients. By contrast, subtle abnormalities of LV and LA morphology as well as 2D global longitudinal strain were found in a significant proportion of these asymptomatic patients. These results suggest that a systematic screening of DM2 patients by doppler- echocardiography with 2D global longitudinal strain is useful for the early detection of cardiac abnormalities.