Pragmatic clinic-based investigation of echocardiogram parameters in asymptomatic patients with type 2 diabetes in routine clinical practice and its association with suggestive coronary artery disease: A pilot study

Abstract

Background Patients with Diabetes Mellitus (DM) have cardiovascular diseases (CVD) as a major cause of mortality and morbidity. The primary purpose of the study was to assess the echocardiographic parameters that showed alterations in patients with type 2 diabetes mellitus(T2DM ) with suggestive coronary artery disease (CAD) determined by electrocardiography and the secondary was to assess the relationship of these alterations with established cardiovascular risk factors. Methods This cross-sectional, observational pilot study included 152 consecutive patients with T2DM who attended a tertiary diabetes outpatient care center. All patients underwent clinical examination and history, anthropometric measurements, demographic survey, determination of the Framingham global risk score, laboratory evaluation, basal electrocardiogram, echocardiogram, and measurement of carotid intima-media thickness (CIMT). Results From the overall sample, 134 (88.1%) patients underwent an electrocardiogram. They were divided into two groups: patients with electrocardiograms suggestive of CAD (n = 11 [8,2%]) and those with normal or non-ischemic alterations on electrocardiogram (n = 123 [91,79%]). In the hierarchical multivariable logistic model examining all selected independent factors entered into the model, sex, high triglyceride levels, and presence of diabetic retinopathy were associated with CAD in the final model. No echocardiographic parameters were significant in the multivariate analysis. Conclusion Our pilot study demonstrated that no echocardiogram parameters could predict or determine CAD. The combination of CIMT and Framingham risk score is ideal to determine risk factors in asymptomatic patients with T2DM. Patients with diabetic retinopathy and hypertriglyceridemia need further investigation for CAD. Further prospective studies with larger sample sizes are needed to confirm our results.