ABC | Volume 113, Nº2, August 2019

Original Article Kul et al PSW and type 2 DM Arq Bras Cardiol. 2019; 113(2):207-215 groups in terms of left ventricular mass (LVM), left ventricular mass index (LVMI), body mass index (BMI), BSA and duration of DM. There were no patients with LVH in both groups. Biochemical parameters of the study population are shown in Table 1. Serum fasting glucose, serum creatinine, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, TG, and hemoglobin A1C were not different between both groups. There was no difference between the glomerular filtration rate of both groups. There was no difference between white blood cells, hemoglobin, platelet, mean platelet volume and red distribution width between the two groups. The echocardiographic characteristics of the PSW-positive and negative groups are shown in Table 2. Left ventricular ejection fraction, left atrial diameter, interventricular septal diameter, S velocity, mitral E deceleration time were similar in the PSW-positive and negative groups. Left ventricular end diastolic diameter (LVEDd) and posterior wall diameter was similiar in both groups. Doppler echocardiographic variables are shown in Table 2. Em, and septal E' wave velocities were greater in the PSW‑negative group but Am and septal A' wave velocities were greater in the PSW-positive group. Em to Am ratio and septal E’ to A’ ratio were greater in the PSW-negative group. MPI was greater in the PSW-positive group (0.52 ± 0.13 vs 0.63 ± 0.17, p < 0.001) (Figure 3). Univariate analysis showed that the presence of PSW associated with abnormal MPI (p = 0.031) (Table 3). In addition, subclinical left ventricle dysfunction was more prevalent in the PSW-positive group (p = 0.029). The Pearson correlation analysis showed that PSW velocity was significantly correlated with mitral A wave (r: 0.402, p < 0.001) and septal A’ (r: 0.493, p < 0.001) velocities. PSW velocity was correlated with MPI (r: 0.286, p = 0.006) (Figure 4). The Spearman correlation analysis demonstrated that PSW velocity was significantly negatively correlated with Em to Am ratio (r: –0,527, p < 0.001) and septal E’ to A’ ratio (r: -0.572, p < 0.001). Discussion We demonstrated an overall prevalence of PSW of 69% among type 2 DM with preserved LV ejection fraction. As compared to those without, patients with PSW had a significantly higher prevalence of subclinical LVD. Furthermore, PSW had a correlation with subclinical LVD among these patients. A PSW is formed late in diastole commonly encountered on Doppler examination of the LVOT, which has been linked to LVDD. 16 Mittal et al. 16 showed a direct correlation between PSW velocity and transmitral A wave velocity; significant inverse correlation with the Em to Am ratio; and no correlation with age and LVM. 16 Joshi et al. 22 reported a significant correlation between PSW velocity with mitral A- wave velocity and septal A’ velocity. 21 Among hypertensive patients, Akyuz et al. 23 showed that PSW velocity was directly correlated with lateral A’ wave velocity and inversely with the Em to Am ratio. 23 We detected a significant direct correlation between PSW velocity and mitral A-wave velocity, septal A’ wave velocity but there was a significant inverse relation with the mitral E to A ratio and septal E’ to A’ ratio. Akyuz et al. 23 demonstrated a significant correlation between PSW velocity and age, LVM among hypertensive patients. 23 Figure 1 – Arrow shows the PSW. PSW, presystolic wave. 209