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February 28, 2026Cureus0 citationsOpen Access

Determinants of Left Ventricular Diastolic Dysfunction in Normotensive Patients With Type 2 Diabetes Mellitus: A Tertiary Hospital-Based Study in Ghana

FFForster Nketiah FokuohAYAbdul-Subulr YakubuFAFranscis Agyekum

Key Result

Mild left ventricular diastolic dysfunction was present in 42.7% of normotensive Ghanaian patients with type 2 diabetes mellitus, with older age (aOR 1.160), increased septal wall thickness (aOR 7.628), and higher heart rate (aOR 1.037) independently associated with LVDD.

Key Points

  • This study aims to estimate the prevalence and identify factors associated with LVDD in normotensive patients with T2DM.
  • Descriptive cross-sectional design conducted at Korle-Bu Teaching Hospital.
  • Echocardiography performed to assess left ventricular diastolic function.
  • Data collected from randomly selected normotensive T2DM patients between January and December 2016.
  • Grading of LVDD based on mitral inflow velocities and tissue Doppler imaging.
  • Of 365 participants, 42.7% exhibited evidence of LVDD, primarily grade 1.
  • Older age, increased septal wall thickness, and higher heart rate were associated with LVDD.
  • Participants with LVDD were more likely to show symptoms.

Study Design

Type

Cross-Sectional (n=365)

Randomization

Simple balloting random selection among eligible patients

Multicenter

No

Structured PICO

P
Population
356 normotensive adults aged 35-65 years with type 2 diabetes mellitus, mean age 50.7, 69.1% female, attending a tertiary hospital in Ghana. Exclusions: controlled hypertension, type 1 diabetes, valvular heart disease, symptomatic heart failure, history of myocardial infarction, or congenital heart disease.
O
Outcome
Prevalence and determinants of left ventricular diastolic dysfunction (LVDD) assessed by transthoracic echocardiographysurrogate

Mild left ventricular diastolic dysfunction is highly prevalent (42.7%) among normotensive Ghanaian patients with type 2 diabetes mellitus and is independently associated with older age, increased septal wall thickness, and higher resting heart rate.

Main Result

Effect estimate: 42.7% prevalence (95% CI 37.5%-47.9%) (95% CI 37.5%-47.9%)

Limitations

  • Single-center design may limit generalizability.
  • No coronary anatomy data to exclude coronary artery disease.
  • Masked hypertension could not be excluded due to lack of out-of-office BP monitoring.
  • Cross-sectional design limits causal inference and raises risk of reverse causation.
  • Usage of 35-65 age range may omit younger or older diabetic patients.
  • Assessment of diastolic function mainly with pulsed and tissue Doppler methods only.
  • No longitudinal follow-up to assess prognostic significance of LVDD.
  • No standardized effect sizes calculated; multiple comparisons increase risk of type I error.
  • Single-center design
  • Coronary anatomy was not available to exclude epicardial CAD
  • Masked hypertension could not be excluded as out-of-office blood pressure monitoring was not performed
  • Cross-sectional design limits causal inference
  • Age restrictions (35-65 years) limit generalizability
  • Multiple comparisons were performed increasing the risk of type I error

Abstract

Background Diabetes mellitus is a growing global health challenge, with significant cardiovascular complications among affected populations. Left ventricular diastolic dysfunction (LVDD) represents an early manifestation of diabetic cardiomyopathy and predicts adverse outcomes. Data on LVDD in normotensive patients with type 2 diabetes mellitus (T2DM) in Ghana are limited. This study aimed to estimate the prevalence and identify determinants of LVDD among normotensive T2DM patients presenting to the Korle-Bu Teaching Hospital in Ghana. Methodology This was a descriptive cross-sectional study of randomly selected normotensive T2DM patients attending the National Diabetes Management and Research Centre at the Korle-Bu Teaching Hospital between January 2016 and December 2016. Transthoracic echocardiography was performed, and left ventricular diastolic function was assessed and graded based on pulsed Doppler of the mitral inflow velocities and tissue Doppler imaging of the mitral annuli. Results Three hundred and sixty-five participants were recruited, of whom 254 (69.6%) were female. The mean age of the participants was 50.7 ± 8.2 years. Of the 365 participants enrolled, 356 (97.5%) had complete echocardiographic data; nine participants with inconclusive findings were excluded from the analysis. One hundred and fifty-two participants (42.7%, 95%CI 37.5%-47.9%) had evidence of LVDD, comprising mostly grade 1 LVDD (96.1%). Older age (aOR 1.160, 95%CI 1.108-1.214, p<0.001), increased septal wall thickness (aOR 7.628, 95%CI 1.160-50.176, p=0.035), and a higher heart rate (aOR 1.037, 95%CI 1.007-1.067, p=0.016) were independently associated with the presence of LVDD. Participants with LVDD were more likely to be symptomatic. Conclusion Mild LVDD was common among normotensive Ghanaian patients with T2DM, with age, heart rate, and cardiac remodeling associated with its presence. These findings underscore the potential value of echocardiographic screening in this population, while longitudinal studies are needed to establish prognostic significance.

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Cite This Study

Fokuoh et al. (2026) conducted a cross-sectional in Normotensive Ghanaian adults aged 35-65 years with type 2 diabetes mellitus (n=365). Mild left ventricular diastolic dysfunction was present in 42.7% of normotensive Ghanaian patients with type 2 diabetes mellitus, with older age (aOR 1.160), increased septal wall thickness (aOR 7.628), and higher heart rate (aOR 1.037) independently associated with LVDD.

synapsesocial.com/papers/69a287350a974eb0d3c02b21https://doi.org/10.7759/cureus.104317
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Also Consider

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