P519Correlation of PEP and pulse wave velocity in diagnosis of subclinical high cardiovascular risk in diabetic patients

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Abstract

Purpose: PEP ( Presystolic period) and PWV(Pulse wave velocity ) measurements to assess and predict early cardiac (sub clinical) involvement in asymptomatic diabetic patients.

Methods : 610 diabetic patients coming to Om Diabetes Centers without known heart history or complaints - subjected to routine investigations like Colin vascular profiler 1000( U S FDA approved) were at randomly selected for the study. All these patients history ,Clinical parameters ,waist -hip ratio BMI- biochemical parameters , and ECG were studied retrospectively. All these 610 Colin vascular reports analysis done retrospectively for systolic time intervals like PEP, ET, ET/PEP ratio and baPWV.

PARAMETER NORMAL VALUES INTERPRETATION OF ABNORMAL VALUES :

PEP (Pre Ejection Period) 86-106 ms deviation beyond 2SD (66ms&126 ms) warrants left Ventricular Dysfunction

ET (Ejection Time) 260-310 ms deviation beyond 2SD (210ms- 360ms) warrants left Ventricular Dysfunction

ET/PEP (Ejection Index) 2.5 -3.6 deviation beyond 2SD (1.4&4.7) warrants left ventricular Dysfunction

PEP/ET (PEP Index) 30%to 40% deviation beyond 2SD (20% and 50%) warrants left ventricular Dysfunction

BaPWV 1400cm/s more than 1400 cm/s implies significant atherosclerosis value up

Value above 36% high CV risk

Results : ET and ET /PEP was abnormal only in 8 and 25 patients respectively and this finding was not statistically significant. However out 610 patients total 63 (10%) patients had abnormal PEP warranting sub clinical left ventricular dysfunction. 210 patients had both leg ba PWV abnormal implying significant atherosclerosis and high CV risk and all these values were statistically highly significant. But there was no statistically significant difference between male and female in both PEP and baPWV interpretation.

Table:

PARAMETERS MALE FEMALE TOTAL

NO OF PATIENTS 323(53%) 287(47%) 610

PEP 35 ( 11%) 28( 10%) 63(10%)

BaPWV 114( 35% ) 96(33%) 210(34%)

Conclusion: Analyses of specific intervals of the cardiac cycle have indicated that the systolic pre ejection period (PEP) may serve as a reliable index of SNS activity independent of parasympathetic inhibition. Use of systolic time intervals to predict early left ventricular dysfunction and pulse wave velocity to predict high CV risk can be used to plan therapeutic interventions and therapeutic exercise in asymptomatic diabetic patients well in advance. Thus measuring this parameters periodically as routine investigations my help in preventing and to some extent reversing early atherosclerosis and thus reducing Future cardiovascular risk in diabetic patients.

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