Study of the Echocardiographic Changes in Patients with Diabetic Nephropathy

Background: Diabetes mellitus (DM) is a metabolic disorder of multiple etiologies. Cardiovascular changes are one of the important macro vascular complications which are a major cause of mortality in diabetic patients with diabetic nephropathy. The aim of this work was to evaluate the structural and functional cardiovascular changes using echocardiography in diabetic patients with diabetic nephropathy (DN) in comparison with those without diabetic nephropathy.  
Methods: This observational cross-sectional study was carried out on 60 diabetic patients with type 2 diabetes mellitus (T2DM) only or had T2DM with DN Patients were subdivided in to two equal groups: group A included patients without DN and group B included patients with DN. All patients were subjected to laboratory investigations, echocardiography (tricuspid annular plane systolic excursion (TAPSE), pulmonary artery pressure measuring, left ventricular systolic and diastolic function assessment). 
Results: There was a significantly lower Hb and significantly higher creatinine level and AL/CR ratio in group B in comparison to group A. There was significantly higher number of sclerotic aortic valve patients, higher numbers of low TAPSE, higher estimated systolic pulmonary artery pressure (ESPAP), higher end diastolic diameter (EDD), higher end systolic diameter (ESD), heavier left ventricular mass and thicker posterior wall thickness in group B in comparison to group A (P ≤ 0.05). There was a positive relationship between AL/CR ratio and EDD, left ventricular mass, TAPSE, and posterior wall thickness, while negative relationship between it and ESD in the two studied groups, and it was found that high EPASP and sclerosis of the Aortic valve were more prevalent with DN group. 
Conclusions: Risks of cardiovascular events increase substantially with increasing stage of kidney disease in T2DM patients. Asymptomatic diabetic subjects are at high risk for major adverse cardiovascular events, such as those with, chronic diabetic kidney disease (DKD), or proteinuria.