Thesis (Ph.D)-Cairo University, 2025.

Bibliography: pages 126 -158.

Background: Early dysglycemia, including pre-diabetes and early Type 2 Diabetes
Mellitus (T2DM), triggers oxidative stress, causing endothelial dysfunction, intra-
renal arterial stiffness, and subclinical cardiac issues such as myocardial ischemia and
fibrosis, even without epicardial artery disease. Advanced imaging techniques can
detect these subtle changes.
Aim: To evaluate left ventricular (LV) and left atrial (LA) function using Tissue
Doppler Imaging (TDI) and 2D Speckle Tracking Echocardiography (2D STE), and
their relationship with intra-renal artery compliance assessed by renal power Doppler
ultrasonography in early dysglycemia.
Mehtods: This observational case-control study, conducted at Kasralainy Hospitals
from December 2023 to February 2025, enrolled 180 participants: 60 recently
diagnosed T2DM patients (≤2 years), 60 pre-diabetic individuals (per ADA 2024
criteria), and 60 healthy controls, aged 18–50, normotensive, and matched for age,
gender, BMI, and waist circumference. Assessments included glycemic profile
(fasting blood sugar, 75g OGTT, HbA1c), lipid profile, urinary albumin-to-creatinine
ratio (ACR), echocardiographic parameters via 2D STE, and renal arterial indices,
particularly Renal Resistance Index (RI), via renal power Doppler ultrasound.
Results: Compared to controls, T2DM and pre-diabetic groups had significantly
higher eGFR, total cholesterol, triglycerides, LDL, and diastolic dysfunction (grades I
and II) (P<0.05). Despite normal ranges, both groups showed impaired diastolic
indices (higher E/e, lower MV E/A ratio, lower LA strain) and systolic indices (lower
ejection fraction, global longitudinal strain [GLS]) (P<0.05). Renal RI was
significantly elevated in both groups, with T2DM showing higher values than pre-
diabetics (P<0.05). Glycemic markers and ACR correlated positively with E/e and RI
and negatively with LA strain and GLS (P<0.05). RI positively correlated with E/e
and negatively with septal S, indicating a link between diastolic/systolic impairment
and renal arterial resistance.
Conclusion: Despite normal range, Compared to controls, early T2DM & Pre-
diabetic groups showed significantly impaired left atrial & ventricular diastolic &
systolic indices paralleled with increased intrarenal arterial resistance. Worsening of
these cardiac and renal indices correlate with dysglycemic markers & Albuminuria;
hence early T2DM &pre-diabetes are associated with subclinical LV, LA dysfunction
and renal arterial stiffness. So, early 2D STE and Renal artery power Doppler
screening may identify at-risk individuals, enabling timely intervention to prevent
cardiac & renal complications.

هدفت هذه الدراسة إلى تقييم وظائف البطين الأيسر والأذين الأيسر باستخدام تخطيط صدى القلب بتتبع النقاط ثنائي الأبعاد وارتباطها بطواعية الشرايين داخل الكلى لدى ستين فردًا في مرحلة ما قبل السكري، وستين فردًا تم تشخيصهم حديثًا بمرض السكري من النوع الثاني (مدة المرض سنتان أو أقل)، وستين فردًا أصحاء متطابقين في العمر والجنس، تتراوح أعمارهم بين ثمانية عشر إلى خمسين عامًا، وهم غير مصابين بارتفاع ضغط الدم وبدون أمراض مصاحبة، ومتطابقين في مؤشر كتلة الجسم ومحيط الخصر.

Issues also as CD.

Text in English and abstract in Arabic & English.