Microalbuminuriaand Carotid Intima Media Thickness as Predictors of Left Ventricular Function in Diabetic Patients as Assessed by Myocardial Performance Index

Background- Diabetes mellitus promotes deleterious changes in the coronary microvasculature. Left ventricular structural abnormalities, abnormal filling pressures and impaired relaxation occurs in the early stages of diabetes mellitus. Myocardial performance index has been suggested as a non invasive and reproducible method for better evaluation of global lv function. Microalbuminuria has been identified as the earliest sign of diabetic nephropathy. Albuminuria is now considered as a significant predictor of cardiovascular morbidity and mortality in patients with diabetes mellitus. Carotid intima media thickness is used commonly as a noninvasive test for the assessment of degree of atherosclerosis. Methods - This is a prospective observational study done in diabetic patients attending cardiology OPD in chengalpattu medical college. The study done in 275 diabetic patients over a period of 6 months. Microalbuminuria detected by Albumin creatinine ratio and carotid intima media thickness assessed by ultrasound vascular probe. Both parameters were compared and correlated with left ventricular MPI. Results - Among 275 patients; 147 were males and 128 were females. Mean duration of diabetes was found to be 8 years. LV MPI was increased in 96 patients (35%) and MPI values were normal in 179 patients (65%).161 patients (58%) had microalbuminuria. Among 96 patients with increased MPI values, microalbuminuria was significantly elevated, hence had a sensitivity of 85.4% and specificity of 55.8%. CIMT was found to be abnormal in 71 patients (25%). Similarly, CIMT was 54% sensitive and 89% specific when correlated with LV dysfunction. When both microalbuminuria and CIMT tests were combined, the sensitivity rose to 93% and but specificity remained at 48%. Conclusion - Microalbuminuria was found to have higher sensitivity and CIMT had higher specificity. When both tests were done, the combination had significantly higher sensitivity (93%). Hence when both these tests are combined in diabetic patients, we can identify the LVdysfunction with considerable sensitivity.