31.12.31 Exercise Electrocardiogram Testing in Asymptomatic Patient with Type-II Diabetes and Left Ventricular Diastolic Dysfunction

Original Article

 

EET in  Asymptomatic with Type-II Diabetic and LVDD    

Exercise Electrocardiogram Testing in Asymptomatic Patient with Type-II Diabetes and Left Ventricular Diastolic Dysfunction

Zeeshan Hassan1, Aamir Siddique2 and Zaheer ud Din Babar3

ABSTRACT

Objective: To find the exercise electrocardiogram testing in asymptomatic patient with Type-II diabetes and left ventricular diastolic dysfunction.

Study Design: Descriptive study

Place and Duration of Study: This study was conducted at the Allama Iqbal Memorial Teaching Hospital, Sialkot during January 2019 to November 2019.

Materials and Methods: The data was collected from 50 patients of type II DM. These all patients has normal electrocardiogram (ECG) and normal systolic function.

Results: The data was collected from 50 patients of both genders. The mean age of the patients was 47.83±5.61 years. After getting data the results were divided into two parts. There were 25 patients in group A and 25 patients group B. The mean duration of diabetes is 2.5±5.61 years. There were 20 males and 30 females in this data. There were no significant difference of fasting blood sugar in both groups. There was no statically significant difference between two groups regarding left atrial dimension, aortic root dimension, LV end-diastolic dimension, ejection and LV mass.

Conclusion: It is concluded that It is concluded that coronary supply route sicknesses is a typical issue in DM, with diastolic brokenness and increment uniquely in patients with positive pressure practice electrocardiography.

Key Words: Electrocardiogram Testing, Asymptomatic Patient, Type-II Diabetes, Left Ventricular Diastolic Dysfunction

Citation of article: Hassan Z, Siddique A, Babar Z. Exercise Electrocardiogram Testing in Asymptomatic Patient with Type-II Diabetes and Left Ventricular Diastolic Dysfunction. Med Forum 2020;31(12):135-138.

 

 

INTRODUCTION

Patients with type 2 diabetes often complain of fatigue and reduced exercise capacity which might be related to other illness conditions, for example, hypertensive left ventricular hypertrophy as well as coronary supply route sickness, and the resulting improvement of cardiovascular breakdown, however the presence of diabetes may freely add to the hindered practice limit. A few examinations have uncovered that activity limit diminishes in patients with type 2 diabetes and is related with cardiovascular mortality1.

 

 

1. Department of Cardiology, Government Khawaja Muhammad Safdar Medical College, Sialkot.

2. Wazirabad Institute of Cardiology, Wazirabad.

3. Department of Cardiology, Tehsil Headquarter Civil Hospital Daska, Sialkot.

 

 

Correspondence: Dr. Zeeshan Hassan, Assistant Professor of Cardiology at Government Khawaja Muhammad Safdar Medical College, Sialkot.

Contact No: 03214079977

Email: zee_196@hotmail.com

 

 

Received:     March, 2020

Accepted:     August, 2020

Printed:        December, 2020

 

 

 

 

The proof demonstrates that in patients with type 2 diabetes, myocardial harm with fibrosis and apoptosis, disappointment in energy utilization, little vessel illness and autonomic neuropathies influence diastolic capacity before systolic capacity which is autonomous of hypertension and coronary corridor infection and prompts diabetic cardiomyopathy2.

Individuals with diabetes (PWD) are at expanded danger of creating both miniature and macrovascular difficulties, which are lessened with legitimate glycaemic treatment. Contrasted and individuals without diabetes, men and, particularly, ladies with diabetes have diminished future (six to eight years less)3. One necessities to remember however that these individuals don't bite the dust from diabetes in essence but instead from cardiovascular sickness (CVD). At the hour of determination of type 2 diabetes (T2D), numerous patients as of now have at least one extra danger factors for macrovascular illness (stoutness, hypertension, dyslipidaemia, and smoking) and many have proof of plain atherosclerosis (past myocardial dead tissue (MI), ischaemic stroke, ischaemic changes on electrocardiogram (ECG), or fringe vascular infection)4.

Doppler echocardiography is one of the most valuable clinical apparatuses for the appraisal of LV diastolic capacity. Doppler lists of LV filling are utilized for analytic purposes as well as for building up guess and assessing the impact of treatment. LV diastolic brokenness may speak to the primary phase of diabetic cardiomyopathy strengthening the significance of the early assessment of diastolic capacity in individual with diabetes5.

Diabetes is related with expanded cardiovascular confusions, the most widely recognized of which are ischemic cardiomyopathy and LV brokenness. Diabetes is likewise connected with HF, basically through its association with hypertension and coronary vein disease.8 Diabetes mellitus (DM) speeds up the cycle of coronary atherosclerosis and practical and basic heart disabilities6.

DM isn't just a huge autonomous danger factor for the improvement of atherosclerotic ischemic coronary illness or ventricular hypertrophy, yet it is likewise ready to trigger a diabetic cardiomyopathy because of some metabolic cycles: restraint of exchanging inside the cardiomyocyte from free unsaturated fat (FFA) to glucose digestion, dysregulation of FFA digestion with expanded take-up, diminished FFA oxidation, decrease of peroxisome proliferator-actuated receptor (PAPAR), increment of PAPAR-g and insulin-obstruction, and expanded intracellular lipogenesis which prompts cardiomyocyte lipotoxicity7.

 

MATERIALS AND METHODS

This descriptive study was conducted in Allama Iqbal Memorial Teaching Hospital, Sialkot during January 2019 to November 2019. The data was collected from 50 patients of type II DM. These all patients has normal electrocardiogram (ECG) and normal systolic function. 

Exclusion criteria: Patients suffering from hypertension, ECG abnormalities and muscular disorder were excluded from this study.

Inclusion criteria: All the patients who have type II DM, and ready to participate in the study.

Data collection: The data was collected from 50 patients. All patients went through complete reverberation Doppler study utilizing an industrially accessible echocardiography machine. LV measurements, left atrial measurements, divider thickness and launch part were estimated. Besides, transmitral stream was finished by beat wave Doppler between the tips of mitral valve flyers from four-chamber see measure top E wave speed, top A wave speed, E/A proportion, E wave deceleration time, and isovolumic unwinding time (IVRT). Exercise ECG was done to all patients to identify ischemic coronary illness and those with positive exercise ECG will inclined to coronary angiography. The data was collected and analysed by using excel 2010.

RESULTS

The data was collected from 50 patients of both genders. The mean age of the patients was 47.83±5.61 years. After getting data the results were divided into two parts. There were 25 patients in group A and 25 patients group B.

Group A: diabetic patients with LV diastolic dysfunction with negative stress ECG

Group B: patients with LV diastolic dysfunction with positive stress ECG.

The mean duration of diabetes is 2.5±5.61 years. There were 20 males and 30 females in this data. There were no significant difference of fasting blood sugar in both groups. There was no statically huge contrast between two gatherings with respect to left atrial measurement, aortic root measurement, LV end-diastolic measurement, launch and LV mass. The exhibition of activity stress test has appeared in diabetics, a lower increment of E' speed (12,02±1,6 cm/sec versus 16,7±1,3 cm/s, p<0,01), slight increment of A' speed (p<0.01) contrasted and control subjects.

Table No.1: Tissue Doppler Echocardiography characteristics of both groups after the stress test

Parameters

Group A

Group B

P

E’ (cm/sec)

12.02±1,6

16.7±1.3

P<0.01

A’ (cm/sec)

12.35±1,8

13.1±1.2

P<0.02

E’/A’

0.89±0.1

1.8±1.2

P<0.01

S’ (cm/sec)

10.22±0.95

12.92±1.2

P<0.01

In group A there were 25 patients who were negative stress exercise in group A and 54% in group B. The statistical analysis showed a significant increase in the number of stress exercise ECG-positive patients among diabetic patients with diastolic dysfunction than diabetic patients without diastolic dysfunction (P< 0.001).

Table No.2: Stress exercise ECG in group A and group B

 

Group A

Group B

X2

P-value

% age

% age

Exercise ECG

+ve

-ve

 

0

100

 

46

54

37

0.001

Functional Capacity

Poor

Average

Good

Excellent

 

0.1

9.9

38.9

61.1

 

9.1

67.8

12.3

11.2

15.91

0.100

DISCUSSION

Diabetes is notable to altogether expand CVD hazard, yet can't be viewed as a CHD same, because of extraordinary heterogeneity of the patients. All things considered, life-time danger of CHD is by all accounts very high in practically all individuals with the infection, which calls for individualized methodology and assessment for the presence and conceivable treatment of an incredible assortment of other as often as possible coinciding danger factors that can expand this danger [8].

Aside from hazard factor treatment, be that as it may, the estimation of obtrusive treatment of coronary atherosclerosis (with the exception of the instance of intense coronary conditions) stays disrupted, on the grounds that all earlier randomized preliminaries have restrictions and are pointing towards equipoise, and accordingly, routine screening for quiet CHD in asymptomatic people with DM isn't right now suggested, as long as cardiovascular danger factors are dealt with [9].

Conversely, old style measures dependent on CE don't appear to have a similar capacity. Moreover, this irregularity is by all accounts related to the diabetic cardiomyopathy. Almost certainly, metabolic variations from the norm may assume a significant job [10]. Exploratory data from creature models of diabetes unequivocally uphold a causal part of insulin obstruction in the advancement of diastolic brokenness. Treatment with metformin forestalled the improvement of cardiomyocite brokenness [11]. In an insulin-safe pre-diabetic rodent model, Mizushige et al. seen that the variations from the norm of diastolic filling happened before the advancement of straight to the point hyperglycaemia [12].

Histopathology contemplates proved expanded myocite fibrosis and collagen statement, recommending that these auxiliary adjustments assume a significant function in the advancement of diastolic brokenness [13]. Another factor that may weaken diastolic capacity is hyperglycaemia. There is trial proof that momentary hyperglycemia can modify cardiomyocite contraction and unwinding. Moreover, high glucose focus causes the arrangement of cutting edge glycation end products (AGE) that change collagen structure and meddle with intracellular calcium taking care of [14]. In people, Fang and partners found an expanded myocardial fibrosis in diabetic patients with heart brokenness. The current examination indicated that aortic sclerosis and mitral annular calcification were practically identical among various gatherings which mean that neither length of DM nor presence of diastolic brokenness has a function in their turn of events. Eren et al. expressed that aortic firmness is expanded in patients with hypertension, diabetes, or both even after the avoidance of coronary corridor sickness. Aortic firmness and LV diastolic brokenness are additionally related in these patients [15].

CONCLUSION

It is concluded that coronary supply route sicknesses is a typical issue in DM, with diastolic brokenness and increment uniquely in patients with positive pressure practice electrocardiography. Patients with positive pressure practice electrocardiography and coronary corridor infection apparent by coronary angiography had a practically identical diastolic capacity record to those with negative pressure practice electro-cardiography. Doppler imaging application may legitimize routine screening for diastolic brokenness in diabetic patients dared to have healthy hearts.

Author’s Contribution:

Concept & Design of Study:

Zeeshan Hassan

Drafting:

Aamir Siddique

Data Analysis:

Zaheer ud Din Babar

Revisiting Critically:

Zeeshan Hassan, Aamir Siddique

Final Approval of version:

Zeeshan Hassan

Conflict of Interest: The study has no conflict of interest to declare by any author.

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