Clinical Investigation
Left Ventricular Mechanics
Impaired Myocardial Radial Function in Asymptomatic Patients with Type 2 Diabetes Mellitus: A Speckle-Tracking Imaging Study

https://doi.org/10.1016/j.echo.2010.09.007Get rights and content

Background

Diabetic cardiomyopathy has been characterized by an early impairment of left ventricular (LV) longitudinal function as opposed to preserved LV radial function.

Methods

Conventional echocardiography and longitudinal (εL) and radial (εR) systolic strain assessed by speckle-tracking imaging were obtained in 114 type 2 diabetic patients and 88 age-matched controls.

Results

LV ejection fraction was similar in diabetic patients and controls. The presence of subclinical LV systolic dysfunction in diabetic patients was demonstrated by lower values of midwall fractional shortening (18% ± 3% vs 20% ± 3%, P = .006), εL (-19% ± 3% vs –22% ± 2%, P < .001), and εR (50% ± 16% vs 56% ± 12%, P = .003) compared with controls. On multivariate analysis, factors predicting strain values were diabetes (P = .001) and gender (P = .001) for εL and diabetes (P = .003) for εR.

Conclusion

Diabetic patients without overt heart disease display subclinical alteration of both radial and longitudinal LV systolic function even after adjustment for blood pressure, age, and body mass index.

Section snippets

Population and Study Protocol

We prospectively enrolled 114 consecutive patients with type 2 DM, referred to the outpatient clinic department of Louis Pradel Hospital (Lyon, France) between February 2006 and March 2008, and 88 age-matched healthy controls, previously enrolled in the Asklepios cohort between October 2002 and October 2004.20

The study inclusion criteria of patients with type 2 DM were as follows: age between 35 and 60 years; oral antidiabetic or insulin treatment; no symptoms, sign, or history of heart

Clinical Characteristics

Table 1 summarizes the clinical and biological characteristics of the age-matched diabetic and control populations. As a result of the selection of a low-risk control population, BMI was lower in the control group compared with the DM group. Mean duration of DM was 11 ± 7 years. In the DM group, 21% (24/114) were smokers, 38% (43/114) were treated for systemic hypertension, and 25% (28/114) were treated for hypercholesterolemia. Antidiabetic treatment consisted of metformin in 74% (84/114),

Discussion

The main finding of this study was to demonstrate a significant decrease in both radial and longitudinal systolic strain values by STI in patients with DM with normal conventional parameters (LVEF, FS) compared with age-matched controls and even more to age, gender, and BMI-paired controls. By multivariate analysis, we showed that the only predictors of decreased systolic strain in diabetic patients were DM and gender for εL and DM only for εR. In addition, the decrease in εR and εL was

Limitations

The DM patient group included more men than our control group. This might have affected the results concerning the difference of radial and longitudinal function between groups. However, the decrease in radial and longitudinal strain in patients with DM compared with controls was still observed when comparison was made between the two strictly paired subgroups in terms of age, gender, and BMI. Circumferential strain was not reported in our study because of high variability. However, FSm was

Conclusions

Patients with DM without overt heart disease display subclinical alteration of both radial and longitudinal LV systolic function even after adjustment for blood pressure, age, and BMI.

References (36)

Cited by (135)

  • Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology

    2021, Archives of Cardiovascular Diseases
    Citation Excerpt :

    However, most often, asymptomatic diabetes patients present with a normal LV ejection fraction. A decrease in LV global longitudinal strain can be observed in 25% or more of patients without known cardiomyopathy [111,112], and has been associated with a higher risk of CV events and death [113,114]. In apparently healthy diabetes patients, diastolic dysfunction is also common [115], but may be linked to age or associated comorbidities, such as hypertension or obesity [116].

  • Prognostic Value of Early Systolic Lengthening by Strain Imaging in Type 2 Diabetes

    2021, Journal of the American Society of Echocardiography
    Citation Excerpt :

    In its first stages, this disease is characterized by a hidden and subclinical course of fibrosis and stiffness of the left ventricle, which often is considered to be associated with diastolic dysfunction.26 However, Ernande et al.27,28 proposed that systolic strain abnormalities to a greater extent represent the first cardiac changes in this disease. This happens because subendocardial longitudinal fibers are the most susceptible to impairment in the early course of diabetic cardiomyopathy when affected by hypoperfusion and fibrosis.29,30

View all citing articles on Scopus

This study was supported by The Association of French Language for the Study of Diabetes Mellitus and Metabolic Diseases (ALFEDIAM, D20515) and by Fonds voor Wetenschappelijk Onderzoek (FWO) Vlaanderen research Grant G.0838.10 (to the Asklepios Study).

View full text