ABC | Volume 113, Nº2, August 2019

Original Article Kul et al PSW and type 2 DM Arq Bras Cardiol. 2019; 113(2):207-215 Table 1 – Demographic and biochemical characteristics of PSW positive and negative patients with type 2 DM Variables PSW - negative (n = 39) PSW- positive (n = 90) p Age (years) 55.31 ± 11.29 57.77 ± 10.91 0.190 Sex, male, n 13 38 0.343 Hypertension, n 16 47 0.257 Current smokers, n 3 10 0,541 Family CAD, n 3 17 0.102 Dyslipidemia, n 7 13 0.632 BMI (kg/m 2 ) 30.42 ± 4.97 31.29 ± 5.80 0.423 BSA (m 2 ) 1.86 ± 0.18 1.87 ± 0.15 0.847 DM year 7 ( 1-10) 7 (4-12) 0.190 LVM, gr 124.17 ± 19.95 123.51 ± 32.86 0.908 LVMI, gr/m 2 67.37 ± 10.15 66.04 ± 16.40 0.647 Biochemical parameters Glucose, mgr/dl 173.43 ± 60.14 179.38 ± 64.60 0.760 Serum creatinine, mg/dL 0.69 ± 0.18 0.78 ± 0.17 0.108 GFR,% 103.14 ± 17.71 91.10 ± 21.85 0.065 Triglyceride, mgr/dl 145.91 ± 90.44 127.67 ± 68.20 0.481 LDL-c, mgr/dl 120.72 ± 44.32 126.85 ± 30.68 0.607 HDL-c, mgr/dl 49.70 ± 11.86 47.73 ± 10.97 0.627 HbA1c, % 8.15 ± 1.74 8.26 ± 1.83 0.844 HbA1c mmol 65.57 ± 19.03 66.87± 19.97 0.842 WBC, x10 9 /L 7.77 ± 2.12 7.47 ± 1.78 0.614 PLT, x10 9 /L 240.85 ± 63.80 244.41 ± 77.61 0.881 Hb, gr/dL 13.44 ± 1.49 13.57 ± 1.59 0.789 RDW, fL 13.6 (12.9-14.9) 13.5 (13.05-14.20) 0.863 MPV, fL 9.31 ± 1.00 8.80 ± 0.94 0.104 BMI: body mass index; BSA: body surface area; CAD: coronary artery disease; DM: diabetes mellitus; LVM: left ventricle mass; LVMI: left ventricle mass index; GFR: glomerular filtration rate; LDL-c: low-density lipoprotein cholesterol; HDL-c: High density lipoprotein cholesterol; WBC: white blood cell; Hb: hemoglobin; RDW: red distribution weight; MPV: mean platelet volume; PLT: platelet. The increased formation of AGEs secondary to hyperglycemia may alter structural proteins and lead to increased myocardial stiffness and impaired LV relaxation. 29 A possible mechanism of PSW is impaired LV compliance and increased LV stiffness. 16,17 Impaired left ventricle compliance and increased stiffness may cause the occurrence of PSW in diabetic patients. In addition, PSW is associated with LVDD. 16 Development of LVDD may be one of the reasons for the occurrence of PSW in diabetic patients. As a result, PSW can be expected to occur in diabetic patients with subclinical LVD. Conclusion Presystolic wave on echocardiography was associated with subclinical LVD in patients with DM type 2. PSW is a simple and easily detectable echocardiographic parameter seen in late diastole and may associated with subclinical left ventricle dysfunction in type 2 DM. Limitations of the study Myocardial structural changes were not tested using imaging modalities. Type 2 diabetic patients alone were included in our study, limiting the use of our findings for the general population. Our findings may have been altered by antidiabetic drugs used by our patients. As our study is a cross‑sectional study, its findings do fall short in making a causal relationship between MPI and PSW. Author contributions Conception and design of the research: Kul S, Dursun I, Ayhan S, Sayin MR, Üçüncü Ö, Bülbül NE, Akyüz AR; Acquisition of data: Kul S, Ayhan S, Üçüncü Ö, Bülbül NE, Akyüz AR; Analysis and interpretation of the data: Kul S, Akyüz AR; Statistical analysis: Kul S, Dursun I, Sayin MR, Ateş AH; Writing of the manuscript: Kul S; Critical revision of the manuscript for intellectual content: Kul S, Dursun I, Ayhan S, Sayin MR, Üçüncü Ö, Bülbül NE, Ateş AH, Akyüz AR. 211