Prevalence of Asymptomatic Left Ventricular Diastolic Dysfunction and Silent Myocardial Ischemia amongst Type 2 Diabetic Patients in Two Referral Hospitals in Cameroon

Abstract

The present study sought to determine the prevalence of asymptomatic LVDD and SMI as well as to assess the relation of LVDD with age, duration of diabetes mellitus (DM), Glycosylated hemoglobin levels (HbA1c), and SMI in type 2 diabetic subjects in two hospitals in Cameroon. Left ventricular diastolic dysfunction (LVDD) represents the earliest preclinical manifestation of diabetic cardiomyopathy, and has fatal complications amongst which, is, rapid progression to symptomatic heart failure. Cardiovascular events, the leading cause of death among diabetic patients, are usually underdiagnosed due to subclinical presentation. The study carried out a cross-sectional study from March 2019 to September 2020, in two reference hospitals in Yaounde, Cameroon, to assess the prevalence of asymptomatic Left Ventricular Diastolic Dysfunction (LVDD) and Silent Myocardial Infarction (SMI) and potentially associated factors. Out of 95 participants (mean age ± SD: 43±7 years; M/F sex-ratio 1.6), 22 (23.1%; 95%CI:15.8%-32.6%) had LVDD and fewer (n=13, 13.6%; 95% CI:8.2%-22.0%) had SMI, p=0.86. Though not statistically significant, patients with\(\ge\)5 years diabetes duration, had increased risk of LVDD (OR: 1.5; p=0.22) as well as patients with HbA1C\(\ge\)7.5% (OR: 2.1; p=0.15), with LVDD being significantly higher in patients with SMI (29% vs 6.3%, p<0.05). The pathophysiology of silent ischemia remains controversial, and several factors may play a role, including differences in plasma opioid receptors, ischemic damage to nerve endings, and psychological factors. The significant presence of asymptomatic cardiovascular manifestations in this population entails mandatory preventive screening, especially, in patients with long standing diabetes and poor glycemic control, to allow timely detection and management. The study suggest that early diagnosis of LVDD and SMI in diabetic patients should be done using tissue doppler echography and exercise stress test respectively especially in older patients with long standing history of DM and those with poor glycemic control, so as to allow for timely detection of these asymptomatic cardiovascular events, for prompt management, hence improving outcome and survival.