The comparison of clinical and echocardiographic changes in diabetics 2nd type and nondiabetics in patients with shortness of breath due to left ventricular failure
Abstract
In our study we have examined 198 patients admitted to hospital for shortness of breath at rest due to left ventricle failure. We have divided the patients into two groups according to the presence of diabetes mellitus.
We have excluded the patients with noncardiac cause of pulmonary congestion, with valvular or congenital heart disease and with acute coronary syndromes. We have evaluated the presence of hypertension, value of blood sugar on admission, systolic and diastolic blood pressure, heart rate and medication given for heart insufficiency.
We have also compared two dimensional transthoracal echocardiogaphic examination in diabetics to nondiabetics. Finally we compared hospital mortality in both groups.
Diabetes mellitus (all the patients were type 2 diabetics) was present in 94 patients (47,5 %), in the group of diabetics there were 50 women, in nondiabetics 52 women (n.s.). The average age of diabetics was 75,5 +/- 8 years and 76,6 +/- 10,1 years in nondiabetics (n.s.).
History of hypertension had 45 nondiabetics (43 %) and 69 diabetics (73,5 %), p < 0.05. Systolic blood pressure was significantly higher in diabetics 151 +/- 20,8 mm Hg to 140,5 +/- 18,4 mm Hg in nondiabetics, p < 0.05.
The values of diastolic pressure and heart rate were comparable in both groups. We have not noticed any significant difference in the application of ACE inhibitors, beta blockers and diuretics for heart failure in both groups.
Echocardiographic examination revealed the significantly higher ejection fraction of left ventricle in diabetics as well as the thicker septum and posterior wall of left ventricle. These findings support the role of the diastolic dysfunction in pathogenesis of left ventricle failure.
In hospital mortality rate was 8,5 % in diabetics and 7,6 % in nondiabetics (n.s.). Our results confirmed that in pathogenesis of left ventricle failure hypertension and elevated systolic blood pressure play the important part.
Apart from the complex secondary prevention of ischemic heart disease the correct treatment of hypertension represents the very important part of the prevention of left ventricle failure. The role of the proper compensation of diabetes mellitus in the prevention of left ventricle failure is also discussed.