Association of Microalbuminuria with Abnormal Left Ventricular Geometry Patterns in Nigerian Normotensive Type 2 Diabetic Patients

Abstract

To compare left ventricular (LV) geometry patterns among normotensive type 2 diabetics (NT2DM) with normoalbuminuria, NT2DM with microalbuminuria and healthy controls. A cross-sectional study conducted at the medical outpatient department of a Teaching Hospital from January 2013 to March 2014. Sixty-three normoalbuminuric NT2DM, 71 microalbuminuric NT2DM and fifty-nine healthy controls were recruited. Microalbuminuria was tested for using Micral test strips (Roche, Germany). Trans-thoracic echocardiography was carried out on all subjects. Relative wall thickness (RWT), left ventricular mass index (LVMI) and LV geometry patterns were compared among the three groups. The three groups were age and sex-matched and appropriate statistical tests were used for comparisons with p<0.05. The proportions of abnormal LV geometry (33.3% vs 71.4% vs 84.5%), LVMI and RWT showed a significant stepwise increase from healthy controls through normoalbuminuric NT2DM and to microalbuminuric NT2DM (all p<0.01). Concentric remodeling (CR) was the commonest pattern among the three groups. Left ventricular mass index and RWT correlated significantly with duration of DM and body mass index (all p< 0.01). Microalbuminuria showed a strong direct association with abnormal LV geometry (OR 3.27, 95% CI 1.63-6.57, p<0.01) while duration of DM was found to be an independent predictor of LV geometry remodeling (OR 1.23, 95% CI 1.02-1.49, p = 0.03) among normotensive diabetics. Although CR was the commonest pattern across the three patient groups, those with microalbuminuria had the highest proportion and risk of LV remodeling. Early screening and prompt treatment of microalbuminuria in NT2DM is hereby recommended.