الفهرس 
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Abstract
The current prospective, analytic, hospital based study, was carried out at the Internal Medicine Department and cardiology department, Minia University Hospital in collaboration with endocrine unit, cardiology department and clinical pathology department, Armed Forces Medical Complex, from October 2018 to December 2019.
The aim of the study was to investigate the clinical and Echo characteristics of diabetic patients with abnormally elevated serum GGT and its association with L.V. diastolic dysfunction and hypertrophy in diabetic patients.
It was conducted on a group of patients with diabetes mellitus who were selected from those consecutively attended to Diabetic and endocrine Unit at The Internal Medicine Department, Minia University Hospital. Diabetic and endocrine Unit and in Armed Forces Medical Complex.
Our study included 50 diabetic patients with elevated GGT enzyme levels. This group of patients was compared to another group including 50 diabetic patients with normal GGT enzyme levels.
All the study subjects were submitted to:
• Careful clinical history
• Thorough clinical examination
• Laboratory investigations including :
- CBC
- Complete liver function
- Lipid profile
- Renal functions
- Fasting , 2hours post prandial blood glucose , HbA1c and fasting insulin
- hsCRP , INR
- viral markers including anti HCV , HBsAg and HIV Ab
• imaging study including
- Abdominal ultrasonography
- ECG, Stress ECG and Echocardiography
The mean of age and BMI was significantly higher in patients with normal GGT level when compared to those with elevated GGT level and the number of well controlled diabetic patients in G1 were high compared to G2 and Both SBP and DBP were higher in group of diabetics with high GGT level than those without.
When patients with elevated GGT level compared to those without, there were significantly higher levels of ALT, AST, Alkaline Ph., INR, hsCRP, and there were significantly lower levels of hemoglobin and albumin.
Diabetic patients with high GGT level had significantly higher levels of post prandial blood glucose, HbA1c and fasting insulin Compared to those without elevated GGT level. Also the mean of FBS and HOMA-IR were higher among patients of G2 than G1, but there was no significant difference between both groups. Moreover the number of diabetic patients who had hepatic steatosis was significantly higher in G2 compared to G1.
Echocardiographic finding revealed that G2 exhibited significantly higher frequency of diastolic dysfunction compared to G1. Furthermore, G2 exhibited significantly higher frequency of DDG1 and DDG2 compared to G1
G2 had significantly higher values of IVRT, A wave, DT, IVS compared to G1. While they had statistically significant lower values of E/A ratio and there was no significant difference between both groups as regard EF %.
We found that degree of DD had significantly negative correlation with albumin and E/A ratio, and significantly positive correlation with age, SBP, DBP, SBP.HTN, DBP.HTN, HTN, Uncontrolled DM, TLC, ALT, AST, T. BIL., INR, cholesterol, Post Prandial blood sugar, GGT, Fasting Insulin, hepatic steatosis, DT, IVS, PWT, IVRT and A wave.
There was No significant correlation had been found between degree of DD and between BMI, pulse, Hb, PLT, Creatinine, Urea, Uric Acid, Alkaline Ph., TGs, HDL, LDL, Fasting blood Glucose, HbA1C, hsCRP, HOMA IR and EF%.
Our results showed that AU-ROC curve for GGT was 0.8 (95% CI= 0.71-0.87; p <0.001). At a cut-off point of >45, the sensitivity was 100% and the specificity was 72%. It showed PPV of 78.1% and, NPV of 100% and accuracy of 86%.
Conclusion:
• Heart failure is a globally health problem with high serious outcomes.
• Prediction of early development of heart failure can decrease mortality and morbidity
• High level of GGT even within normal range are associated with more insulin resistance and greater risk for development of T2DM.
• GGT may play a potential role in the development of subclinical LVDD and LV hypertrophy.