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Abstract
Objective: To determine the frequency of silent cardiac failure in diabetic patients and to assess the clinical and echocardiographic characteristics of affected patients presenting to a tertiary care health facility.
Type of Study: Cross-Sectional Study
Place and Duration of Study: This study was conducted at the Department of Internal Medicine, Cardiology, and Endocrinology, Combined Military Hospital(CMH), Rawalpindi, from June 2024 to January 2025.
Methodology: This study included a total of 203 patients aged 45 years and above with established diabetes mellitus (Type 1 or Type 2) for ≥5 years that fulfilled the exclusion and inclusion criteria. Detailed history was taken including duration of diabetes, glycemic control status, presence of diabetic complications, and systematic review for heart failure symptoms. Blood samples were collected for NT-proBNP levels, HbA1c, and complete metabolic panel. Patients with elevated NT-proBNP levels (>125 pg/mL) underwent comprehensive 2D echocardiography. Silent cardiac failure was diagnosed based on elevated cardiac biomarkers with echocardiographic evidence of left ventricular dysfunction in the absence of typical heart failure symptoms. Data was analyzed using SPSS version 28, with Chi-square test and logistic regression used to identify predictors. A p-value ≤0.05 was considered statistically significant.
Results: A total of 203 individuals participated in our study. Out of the total, 121 (59.6%) were male with the mean age of 58.34±8.92, and 82 (40.4%) were females with the mean age of 57.18±9.45. The overall frequency of silent cardiac failure was found to be 17.2% (35/203 patients). Among these, 22 patients (62.9%) had silent heart failure with preserved ejection fraction (HFpEF) and 13 patients (37.1%) had silent heart failure with reduced ejection fraction (HFrEF). Echocardiographic findings showed mean left ventricular ejection fraction of 42.6±8.3% in HFrEF patients and 56.2±4.1% in HFpEF patients. Diastolic dysfunction Grade 2 or higher was present in 31 patients (88.6%). A Chi-square test revealed significant associations between diabetes duration, HbA1c levels, and presence of diabetic complications with silent cardiac failure (p<0.001). Patients with diabetes duration >10 years had 3.8 times higher risk of silent heart failure compared to those with shorter duration.
Conclusions: In summary, silent cardiac failure is a clinically important and frequently underrecognized condition in diabetic patients, with a frequency of 17.2% in our population. The condition is predominantly characterized by diastolic dysfunction and heart failure with preserved ejection fraction. Patients with longer diabetes duration (>10 years), poor glycemic control (HbA1c >8%), and presence of diabetic complications are at significantly higher risk. Early detection through systematic screening using cardiac biomarkers (NT-proBNP) and echocardiography can enable timely therapeutic intervention and prevent progression to symptomatic heart failure. Clinicians should maintain high clinical suspicion and implement routine cardiac screening protocols for high-risk diabetic patients to reduce cardiovascular morbidity and mortality.