Abstract
Background: The association of diabetes mellitus (DM) and left ventricular diastolic dysfunction (DD) has been well established. Objective: We aimed to investigate whether better serum glucose control is associated with lower risk of developing DD in diabetic patients. Methods: In this observational retrospective study, we reviewed the echocardiographic results of patients who presented to ambulatory clinics of a tertiary academic medical center. Study population included 1329 DD patients with LVEF>50% and 308 randomly selected normal controls. Demographic, clinical variables and serum hemoglobin A1c (Hb A1c) level were compared between DD patients and normal controls. The same comparison was conducted between patients with impaired relaxation (grade I) and those with pseudonormal (grade II) or restrictive (grade III). Serum A1c was considered as the surrogate of diabetic control. We used logistic regression analysis to examine the association of DM control with DD and its severity, after adjusting for potential confounders. Results: Overall 51.8% of the participants were females. Among 1329 patients with DD 1238 (93.2%) had grade I and 91 (6.8%) had grade II (or higher). DM was reported in 19% of DD patients and 20.1% of normal controls (p=0.0953). However, serum HbA1c was higher among DD patients, compared to normal controls (7.5 vs. 6.4, p=0.005). Multivariable analysis indicated that after adjusting for age, sex, estimated glomerular filtration rate, and history of hypertension, higher serum HbA1c level is an independent correlate of DD (odds ratio: 1.4, 95%CI: 1.1, 1.7, p=0.006). Furthermore, comparison of DM prevalence and serum HbA1c level between grade I DD patients with grade II (or higher) was not statistically significant. Conclusion: The results of this study demonstrated the possible role of better DM control in prevention of DD in diabetic patients. Further studies are encouraged on potential mechanistic pathway that can alleviate diabetes-induced left ventricle dysfunction.
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