European Journal of Cardiovascular Medicine

Type 2 diabetes mellitus (T2DM) has become an epidemic. As of 2021, the International Diabetes Federation estimated that 537 million adults (20-79 years) were living with diabetes. The number is projected to rise to 783 million by 2045 .¹ Cardiovascular complications are the leading cause of morbidity and mortality in patients with T2DM.²Asymptomatic cardiac complications in T2DM include subclinical left ventricular dysfunction, coronary artery disease, and diabetic cardiomyopathy. These complications can progress silently, leading to significant cardiac morbidity and mortality if left undetected.³ Myocardial Performance Index (MPI)⁴, echocardiographic parameter for assessing global cardiac function and NT-pro BNP is a well-known valuable biomarker for the diagnosis, prognosis, and management of heart failure⁵. This study is aimed to evaluated the usefulness of MPI in early detection of cardiac dysfunction in asymptomatic Type 2 Diabetes Mellitus patients.

AIM of Study

The primary objective of the present study is to study Myocardial Performance Index and the serum NT- pro BNP levels in asymptomatic Type 2 Diabetes Mellitus patients.  In addition, the study seeks to correlate Myocardial Performance Index with serum NT- pro BNP levels, age and also glycemic index of the patient in same population.

Study Design & Setting: A hospital-based cross-sectional descriptive study was conducted in the Department of General Medicine, The Oxford Medical College Hospital and Research Centre, Bengaluru.

Duration: July 2023 – January 2025

 Sample Size: 80 asymptomatic T2 DM patients calculated from Gororshi M et al⁶ study.

Inclusion Criteria:

• Individuals aged above 35 years who have given consent for study.
• -Type 2 diabetic for ≥5 years duration and asymptomatic for cardiac illness.
• Willing to provide informed consent

Exclusion Criteria:

• Individuals with hypertension, chronic alcoholism, valvular heart disease.
• Individuals with breathlessness on exertion, history of palpitations, chest pain
• Individuals with previous cardiac bypass surgery, previously done angiogram
• Individuals on long term Steroids
• Individuals who are pregnant

Data Collection: A structured proforma captured demographic data, BMI, FBS, PPBS, HBA1C, NT pro BNP AND MPI. ECG and 2D echocardiography were done and Myocardial performance index was measured using the formula, MPI = IVCT+IVRT/ET. Serum NT-pro BNP levels, HbA1c, FBS, PPBS were measured via lab testing.  Serum NT pro BNP levels were measured using The Finecare NT-pro BNP Rapid Quantitative Test along with Finecare FIA system. After 8 hours of fasting FBS was collected and 2 hours post meal PPBS was collected along with HbA1c, then measured using EM 360 machine employing photometric technique.

 Statistical Analysis: Continuous variables were expressed as mean ± SD. Categorical variables were compared using the chi-square test. Pearson correlation coefficients were calculated to assess relationships between continuous variables, with linear regression for associations. ANOVA, independent t-tests, multiple regression analysis were also used. ROC curve analysis (SPSS v26) was also used. A p value of <0.05 was considered significant.

- Demographics:

Mean age: 57.3±8.4 years; 60% male

Obesity: 83.75%

Mean diabetes duration: 7.9±2.8 years

MPI Distribution:

Normal (<0.40): 26.3%, Mildly abnormal (0.40–0.49): 38.8%, Moderately abnormal (0.50–0.59): 27.5%, Severely abnormal (≥0.60): 7.5%

Correlation:

1)MPI positively correlated with NT-proBNP (r=0.926, p<0.001), age (r=0.782), HbA1c (r=0.854), diastolic dysfunction grade (r=0.845)

2) MPI is Negative correlated with LVEF (r=−0.716)

ROC AUC for NT-pro BNP predicting abnormal MPI: 0.982; cut-off 66 pg/mL yielded sensitivity 95.3%, specificity 90.5%            

MPI and Nt pro BNP levels together have helped to diagnose diastolic dysfunction in patients with known T2DM early before development of symptoms. In our study, MPI is positively correlated with serum NT-pro BNP levels (r=0.26), Age of the patients (r=0.782), HbA1c levels (r value =0.854) and grades of diastolic dysfunction (r value=0.845). A negative correlation with LVEF.

Our findings support previous literature indicating that MPI with Nt pro BNP could serve as early markers for cardiovascular risk tertiary settings.^7,8

From this study we conclude that MPI serves as a simple and non-invasive tool to detect the early systolic and diastolic Left ventricular dysfunction alongside of Nt- pro BNP levels in patients with type 2 diabetes mellitus.

1. International Diabetes Federation. IDF Diabetes Atlas, 10th ed. Brussels, Belgium: International Diabetes Federation; 2021;3. 
2. Emerging Risk Factors Collaboration, Sarwar N, Gao P, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215-2222.
3. Seferović PM, Paulus WJ. Clinical diabetic cardiomyopathy: a two-faced diseas with restrictive and dilated phenotypes. Eur Heart J. 2015;36(27):1718-27.
4. Tei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function— a study in normals and dilated cardiomyopathy. J Cardiol. 1995;26(6):357-66.
5. Patil VC, Patil HV, Shah KB, et al. Diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function. J Cardiovasc Dis Res. 2011;2(4):213-222.
6. Goroshi M, Chand D. Myocardial Performance Index (Tei Index): A simple tool to identify cardiac dysfunction in patients with diabetes mellitus. Indian Heart J. 2016 Jan-Feb;68(1):83-7.
7. Turfan M, Akyel A, Bolayir HA, Vatankulu MA, Aktürk M, Yetkin I, Boyaci B. Correlation of the myocardial performance index with plasma B-type natriuretic peptide levels in type 2 diabetes mellitus and impaired glucose tolerance. Kardiol Pol. 2012;70(6):556-62. English, Polish.
8. Alibaz-Oner F, Gürcan Z, Uzunhasan I, Ergüney M. The effect of glycemic control on myocardial performance index in patients with type 2 diabetes mellitus. Erciyes Tip Dergisi. 2011;33:183-188.