HOMA-IR and Insulin Resistance as Predictors of Subclinical Left Ventricular Diastolic Dysfunction in Normotensive Prediabetic Individuals

Background: Subclinical left ventricular diastolic dysfunction (LVDD) is an early cardiac manifestation in individuals with prediabetes, often preceding symptomatic heart failure with preserved ejection fraction (HFpEF). Despite preserved ejection fraction and absence of hypertension, insulin resistance in prediabetes may contribute to myocardial remodelling and impaired relaxation. Objective: The aim of this study was to assess the prevalence of subclinical LVDD in normotensive prediabetic individuals and evaluate the association between diastolic dysfunction and insulin resistance measured by homeostasis model assessment of insulin resistance (HOMA-IR). Methods: This prospective observational study enrolled 53 normotensive adults (aged 18–60 years) with prediabetes, defined according to American Diabetes Association 2019 criteria. All participants underwent two-dimensional echocardiography with tissue Doppler imaging to assess LVDD. Insulin resistance was quantified using the HOMA-IR. LVDD was diagnosed based on abnormal Early-to-late mitral inflow velocity ratio (E/A) ratio and deceleration time (DT) per modified Tschope criteria. Results: LVDD was identified in 11 of 53 patients (20.8%). Patients with LVDD had significantly higher HOMA-IR values (4.78 ± 1.1) compared to those without LVDD (2.9 ± 0.85, P < .001). All individuals with LVDD were insulin resistant (HOMA-IR ≥ 2.5), whereas only 33.3% of those without LVDD showed insulin resistance. Pearson correlation analysis revealed a strong positive correlation between HOMA-IR and E/A ratio ( r = 0.65, P < .01) and a moderate inverse correlation with DT ( r = –0.58, P < .05). Conclusion: A considerable proportion of normotensive prediabetic individuals exhibits subclinical LVDD, which is strongly associated with insulin resistance. The HOMA-IR may serve as a valuable non-invasive marker for early myocardial dysfunction in prediabetes, potentially enabling risk stratification and early preventive strategies before the onset of overt heart failure.