Tissue Doppler Imaging in the Early Detection of Diastolic Dysfunction in Asymptomatic Diabetic Patients

Introduction Tissue Doppler Imaging (TDI) is a new technique, able to record early changes of subclinical ventricular diastolic dysfunction and potentially identifies diabetic patients who may benefit from earlier treatment in order to prevent heart failure. The Aim To assess the role of TDI in early detection of diastolic dysfunction in asymptomatic diabetic patients (free of dyspnoe, fatigue, exercise intolerance, increased extracellular volume, angina). Methods and Materials Twenty-five asymptomatic diabetic patients and 23 healthy subjects underwent echocardiography (Pulsed-wave Doppler and TDI) to assess diastolic function. We compare the results from both echo-techniques and analyzed the relation of echo cardiographic parameters of diastolic dysfunction (DD) with different risk factors. Results We found statistically significant difference between TDI and PW Doppler (E/E´ vs E/A) in diabetic (Z=-3.17, p<0.001) and control group (Z=-2.4, p<0.003). There was no significant difference in E/A between the groups (Z=0.0, p<1.0). But, TDI identified significantly lower E´ (Z= 2.11, p<0.03) and higher E/E´(Z= -2.12, p<0.03) in diabetic vs control group (Z= -2.12, p<0.03). Also, there is statistically significant difference between the two echocardiographic techniques, TDI vs PW Doppler, in terms of detection of DD in both groups (p<0.00 for diabetic and p<0.01 for control group). Diastolic dysfunction strongly correlate with duration of DM (p<0.00001), age (p<0.00001), female gender (p<0.0001) and obesity indices (BMI, BSA) (p<0.00001, p<0.00001), in both groups. Conclusion TDI identifies DD more frequently than transmitral PW Doppler in asymptomatic patients with or without diabetes.