Preventive cardiology
Findings from Left Ventricular Strain and Strain Rate Imaging in Asymptomatic Patients With Type 2 Diabetes Mellitus

https://doi.org/10.1016/j.amjcard.2009.06.063Get rights and content

Regional left ventricular (LV) myocardial functional changes in early diabetic cardiomyopathy have not been well documented. LV multidirectional strain and strain rate analyses by 2-dimensional speckle tracking were used to detect subtle myocardial dysfunction in 47 asymptomatic, male patients (age 57 ± 6 years) with type 2 diabetes mellitus. The results were compared to those from 53 male controls matched by age, body mass index, and body surface area. No differences were found in the LV end-diastolic volume index (40.7 ± 8.9 vs 44.1 ± 7.8 ml/m2, p = NS), end-systolic volume index (16.0 ± 4.8 vs 17.8 ± 4.3 ml/m2, p = NS), ejection fraction (61.0 ± 5.5% vs 59.8 ± 5.3%, p = NS). The transmitral E/A (0.95 ± 0.21 vs 1.12 ± 0.32, p = 0.007) and pulmonary S/D (1.45 ± 0.28 vs 1.25 ± 0.27, p = 0.001) ratios were more impaired in the patients with diabetes mellitus. Importantly, the diabetic patients had impaired longitudinal, but preserved circumferential and radial systolic and diastolic, function. Diabetes mellitus was an independent predictor for longitudinal strain, systolic strain rate and early diastolic strain rate on multiple linear regression analysis (all p <0.001). In conclusion, the LV longitudinal systolic and diastolic function were impaired, but the circumferential and radial functions were preserved in patients with uncomplicated type 2 diabetes mellitus.

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Methods

A total of 47 patients with type 2 diabetes mellitus were recruited for the present study. The inclusion and exclusion criteria for the diabetic patients have been previously reported.2 In brief, women were not recruited to avoid the possible confounding influences of gender and plasma estrogen levels on lipid metabolism and myocardial triglyceride accumulation. The inclusion criteria for all diabetic patients were (1) type 2 diabetes mellitus diagnosed according to the World Health

Results

The mean age, body mass index, and body surface area was 57.1 ± 6.2 years, 27.0 ± 3.1 kg/m2, and 2.07 ± 0.18 m2, respectively. No significant differences were found between the diabetic patients and controls (Table 1). The median diabetes mellitus diagnosis duration was 4 years (range 1 to 11), and the mean hemoglobin A1c level was 6.4 ± 0.7%. Although no evidence was seen of autonomic neuropathy in the patients with diabetes mellitus, as documented by Ewing's test, the mean heart rate and

Discussion

The results of the present study have demonstrated the presence of subclinical myocardial systolic and diastolic dysfunction in patients with type 2 diabetes mellitus, no diabetic-related complications, and good glycemic control. Despite a normal LV mass, LV volume, and LVEF, the diabetic population showed impairment of LV longitudinal strain and SR but preserved circumferential and radial strain and SR. The presence of diabetes mellitus was an independent predictor of LV longitudinal strain,

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Dr. Bax received grants from Biotronik, Lake Oswego, Oregon; Medtronic, Minneapolis, Minnesota; Boston Scientific, Natick, Massachusetts; Bristol-Myers Squibb Medical Imaging, North Billerica, Massachusetts; St. Jude Medical, St. Paul, Minnesota; GE Healthcare, and Edwards Lifesciences, Irvine, California.

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