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Clinical features of subclinical left ventricular systolic dysfunction in patients with diabetes mellitus.

Mochizuki Y, Tanaka H, Matsumoto K, Sano H, Toki H, Shimoura H, Ooka J, Sawa T, Motoji Y, Ryo K, Hirota Y, Ogawa W, Hirata K - Cardiovasc Diabetol (2015)

Bottom Line: Furthermore, albuminuria significantly correlated with GLS (r = -0.51, p < 0.001), and a multivariate regression model showed it to be the factor most closely associated with GLS (β = -0.33, p < 0.001).Diabetic complications, hypertriglyceridemia and overweight/obesity were closely associated with early stage of LV systolic longitudinal myocardial dysfunction in asymptomatic DM patients with preserved LVEF.Our findings can be clinically noticeable for the management of DM patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. yasuhide820@gmail.com.

ABSTRACT

Background: Left ventricular (LV) longitudinal systolic dysfunction has been identified even in asymptomatic patients with diabetes mellitus (DM) and preserved LV ejection fraction (LVEF). However, its relevant clinical features have not been fully evaluated.

Methods: We studied 144 asymptomatic DM patients without coronary artery disease. Their mean age was 57 ± 15 years, 79 (55%) were female, and mean LVEF was 66 ± 4% (all ≥50%). Global longitudinal strain (GLS) was determined as the average peak strain of 18 segments from the three standard apical views, and was expressed as an absolute value. With the pre-defined cutoff for subclinical LV systolic dysfunction in DM patients with preserved LVEF set at GLS < 18%, this dysfunction was detected in 53 patients (37%).

Results: Multivariate logistic regression analysis revealed that type 2 DM, hypertriglyceridemia, overweight/obesity, nephropathy and neuropathy were independently associated with GLS < 18%, with nephropathy being the highest risk factor (OR: 5.26; 95% CI 2.111-13.12, p < 0.001). For sequential logistic regression models, a model based on clinical variables including gender, type 2 DM and DM duration (χ(2) = 24.1) was improved by addition of overweight/obesity and hypertriglyceridemia (χ(2) = 45.6, p < 0.001), and further improved by addition of nephropathy and neuropathy (χ(2) = 70.2, p < 0.001) as variables. Furthermore, albuminuria significantly correlated with GLS (r = -0.51, p < 0.001), and a multivariate regression model showed it to be the factor most closely associated with GLS (β = -0.33, p < 0.001).

Conclusions: Diabetic complications, hypertriglyceridemia and overweight/obesity were closely associated with early stage of LV systolic longitudinal myocardial dysfunction in asymptomatic DM patients with preserved LVEF. Our findings can be clinically noticeable for the management of DM patients.

No MeSH data available.


Related in: MedlinePlus

Example of color-coded 2-dimensional left ventricular (LV) display derived from the three standard apical views and corresponding peak longitudinal strain values derived from 18 LV segments for measurement of global longitudinal strain (GLS). GLS was determined as the average peak strain of the 18 LV segments, and was expressed as an absolute value.
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Fig1: Example of color-coded 2-dimensional left ventricular (LV) display derived from the three standard apical views and corresponding peak longitudinal strain values derived from 18 LV segments for measurement of global longitudinal strain (GLS). GLS was determined as the average peak strain of the 18 LV segments, and was expressed as an absolute value.

Mentions: Speckle-tracking strain analysis was performed for each patient with the aid of a single dedicated software (EchoPAC version 113; GE Vingmed). GLS was assessed by means of two-dimensional speckle-tracking strain from the three standard apical views as previously described in detail. Briefly, a region of interest was traced on the endocardium at end-systole with a point-and-click approach for each of the three apical views. A second larger region of interest was then generated and manually adjusted near the epicardium. Apical images were divided into six standard segments and six corresponding time-strain curves were generated. GLS was determined as the averaged peak strain of 18 segments from the three standard apical views [19], and was expressed as an absolute value (Figure 1). As previously detailed, the pre-defined cutoff for subclinical LV systolic dysfunction in DM patients with preserved LVEF was set at GLS < 18% [13-15,21].Figure 1


Clinical features of subclinical left ventricular systolic dysfunction in patients with diabetes mellitus.

Mochizuki Y, Tanaka H, Matsumoto K, Sano H, Toki H, Shimoura H, Ooka J, Sawa T, Motoji Y, Ryo K, Hirota Y, Ogawa W, Hirata K - Cardiovasc Diabetol (2015)

Example of color-coded 2-dimensional left ventricular (LV) display derived from the three standard apical views and corresponding peak longitudinal strain values derived from 18 LV segments for measurement of global longitudinal strain (GLS). GLS was determined as the average peak strain of the 18 LV segments, and was expressed as an absolute value.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4404084&req=5

Fig1: Example of color-coded 2-dimensional left ventricular (LV) display derived from the three standard apical views and corresponding peak longitudinal strain values derived from 18 LV segments for measurement of global longitudinal strain (GLS). GLS was determined as the average peak strain of the 18 LV segments, and was expressed as an absolute value.
Mentions: Speckle-tracking strain analysis was performed for each patient with the aid of a single dedicated software (EchoPAC version 113; GE Vingmed). GLS was assessed by means of two-dimensional speckle-tracking strain from the three standard apical views as previously described in detail. Briefly, a region of interest was traced on the endocardium at end-systole with a point-and-click approach for each of the three apical views. A second larger region of interest was then generated and manually adjusted near the epicardium. Apical images were divided into six standard segments and six corresponding time-strain curves were generated. GLS was determined as the averaged peak strain of 18 segments from the three standard apical views [19], and was expressed as an absolute value (Figure 1). As previously detailed, the pre-defined cutoff for subclinical LV systolic dysfunction in DM patients with preserved LVEF was set at GLS < 18% [13-15,21].Figure 1

Bottom Line: Furthermore, albuminuria significantly correlated with GLS (r = -0.51, p < 0.001), and a multivariate regression model showed it to be the factor most closely associated with GLS (β = -0.33, p < 0.001).Diabetic complications, hypertriglyceridemia and overweight/obesity were closely associated with early stage of LV systolic longitudinal myocardial dysfunction in asymptomatic DM patients with preserved LVEF.Our findings can be clinically noticeable for the management of DM patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. yasuhide820@gmail.com.

ABSTRACT

Background: Left ventricular (LV) longitudinal systolic dysfunction has been identified even in asymptomatic patients with diabetes mellitus (DM) and preserved LV ejection fraction (LVEF). However, its relevant clinical features have not been fully evaluated.

Methods: We studied 144 asymptomatic DM patients without coronary artery disease. Their mean age was 57 ± 15 years, 79 (55%) were female, and mean LVEF was 66 ± 4% (all ≥50%). Global longitudinal strain (GLS) was determined as the average peak strain of 18 segments from the three standard apical views, and was expressed as an absolute value. With the pre-defined cutoff for subclinical LV systolic dysfunction in DM patients with preserved LVEF set at GLS < 18%, this dysfunction was detected in 53 patients (37%).

Results: Multivariate logistic regression analysis revealed that type 2 DM, hypertriglyceridemia, overweight/obesity, nephropathy and neuropathy were independently associated with GLS < 18%, with nephropathy being the highest risk factor (OR: 5.26; 95% CI 2.111-13.12, p < 0.001). For sequential logistic regression models, a model based on clinical variables including gender, type 2 DM and DM duration (χ(2) = 24.1) was improved by addition of overweight/obesity and hypertriglyceridemia (χ(2) = 45.6, p < 0.001), and further improved by addition of nephropathy and neuropathy (χ(2) = 70.2, p < 0.001) as variables. Furthermore, albuminuria significantly correlated with GLS (r = -0.51, p < 0.001), and a multivariate regression model showed it to be the factor most closely associated with GLS (β = -0.33, p < 0.001).

Conclusions: Diabetic complications, hypertriglyceridemia and overweight/obesity were closely associated with early stage of LV systolic longitudinal myocardial dysfunction in asymptomatic DM patients with preserved LVEF. Our findings can be clinically noticeable for the management of DM patients.

No MeSH data available.


Related in: MedlinePlus