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01.05.2015 | Original article

Subclinical impairment of left ventricular function in diabetic patients with or without obesity

A study based on three-dimensional speckle tracking echocardiography

verfasst von: Q. Wang, Y. Gao, K. Tan, P. Li

Erschienen in: Herz | Sonderheft 3/2015

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Abstract

Aims

The aim of this study was to investigate subclinical left ventricular (LV) changes between type 2 diabetic patients with or without obesity using three-dimensional speckle-tracking echocardiography (3DSTE).

Methods

A total of 77 type 2 diabetic patients, including 36 subjects with BMI < 25 kg/m² and 41 subjects with BMI ≥ 25 kg/m², as well as 40 age- and sex-matched controls (BMI: 18.5 ~ 24.5 kg/m²) were studied. Waist circumference was measured in diabetic patients with a BMI ≥ 25 kg/m² to determine whether abdominal obesity as a complication was present. Real-time three-dimensional (3D) full volume images of the left ventricle were recorded and analyzed. Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were calculated and compared.

Results

Compared with the controls, diabetic subjects without overall obesity had significantly lower GCS, GAS, and GRS (p < 0.05), as well as markedly lower GLS (p < 0.001). However, 3D-LVEF and all global strains in diabetic subjects with overall obesity were not only markedly lower compared with controls (p < 0.002 and p < 0.001), but also significantly lower than those in diabetic subjects without overall obesity (p < 0.002 and p < 0.05). HbA1c and BMI showed negative impacts on all strains in diabetic patients. Meanwhile, the diabetic subjects with overall and abdominal obesity had significantly reduced GLS, GCS, GAS, and GRS compared with those with overall obesity only (all p < 0.05).

Conclusions

Type 2 diabetic patients demonstrated early-stage subclinical LV deformation and dysfunction, whilst coexistent obesity resulted in further damage to myocardial contractility and reduced LVEF. 3DSTE was a sensitive method for detecting these abnormalities.

Whalley GA, Gusso S, Hofman P et al (2009) Structural and functional cardiac abnormalities in adolescent girls with poorly controlled type 2 diabetes. Diabetes Care 32:883–888CrossRefPubMedCentralPubMed

Alpert MA, Lambert CR, Panayiotou H et al (1995) Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss. Am J Cardiol 76:1194–1197CrossRefPubMed

Ryden L, Grant PJ, Anker SD et al (2013) ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 34:3035–3087CrossRefPubMed

Miyoshi H, Oishi Y, Mizuguchi Y et al (2014) Contribution of obesity to left atrial and left ventricular dysfunction in asymptomatic patients with hypertension: a two-dimensional speckle-tracking echocardiographic study. J Am Soc Hypertens 8:54–63CrossRefPubMed

Geetha L, Deepa M, Anjana RM et al (2011) Prevalence and clinical profile of metabolic obesity and phenotypic obesity in Asian Indians. J Diabetes Sci Technol 5:439–446CrossRefPubMedCentralPubMed

Du T, Sun X, Yin P et al (2013) Increasing trends in central obesity among Chinese adults with normal body mass index, 1993–2009. BMC Public Health 13:327CrossRefPubMedCentralPubMed

Niu J, Seo DC (2014) Central obesity and hypertension in Chinese adults: a 12-year longitudinal examination. Prev Med 62:113–118CrossRefPubMed

Boudina S, Abel ED (2007) Diabetic cardiomyopathy revisited. Circulation 115:3213–3223CrossRefPubMed

Scholte AJ, Nucifora G, Delgado V et al (2011) Subclinical left ventricular dysfunction and coronary atherosclerosis in asymptomatic patients with type 2 diabetes. Eur J Echocardiogr 12:148–155CrossRefPubMed

10.

Nakai H, Tacheuchi M, Nishikage T et al (2009) Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two—dimensional speckle tracking echocardiography: correlation with diabetic duration. Eur J Echocardiogr 10:926–932CrossRefPubMed

11.

Pala S, Esen O, Akcakoyun M et al (2010) Rosiglitazone, but not pioglitazone, improves myocardial systolic function in type 2 diabetic patients: a tissue Doppler study. Echocardiography 27:512–518CrossRefPubMed

12.

Zoroufian A, Razmi T, Taghavi-Shavazi M et al (2014) Evaluation of subclinical left ventricular dysfunction in diabetic patients: longitudinal strain velocities and left ventricular dyssynchrony by two-dimensional speckle tracking echocardiography study. Echocardiography 31:456–463CrossRefPubMed

13.

Ernande L, Bergerot C, Girerd N et al (2014) Impaired longitudinal myocardial strain alteration is associated with left ventricular remodeling in asymptomatic patients with type 2 diabetes mellitus. J Am Soc Echocardiogr 27:479–488CrossRefPubMed

14.

Helle-Valle T, Crosby J, Edvardsen T et al (2005) New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography. Circulation 112:3149–3156CrossRefPubMed

15.

Breaker SJ (2000) The importance of long axis ventricular function. Heart 84:577–578CrossRef

16.

Yan GH, Wang M, Yiu KH et al (2012) Subclinical left ventricular dysfunction revealed by circumferential 2D strain imaging in patients with coronary artery disease and fragmented QRS complex. Heart Rhythm 9:928–935CrossRefPubMed

17.

Deng YB, Liu R, Wu YH et al (2010) Evaluation of short-axis and long-axis myocardial function with two-dimensional strain echocardiography in patients with different degrees of coronary artery stenosis. Ultrasound Med Biol 36:227–233CrossRefPubMed

18.

Zhang X, Wei X, Liang Y et al (2013) Differential changes of left ventricular myocardial deformation in diabetic patients with controlled and uncontrolled blood glucose: a three-dimensional speckle-tracking echocardiography—based study. J Am Soc Echocardiogr 26:499–506CrossRefPubMed

19.

Deng Y, Alharthi MS, Thota VR et al (2010) Evaluation of left ventricular rotation in obese subjects by velocity vector imaging. Eur J Echocardiogr 11:424–428CrossRefPubMed

20.

Cil H, Bulur S, Turker Y et al (2012) Impact of body mass index on left ventricular diastolic dysfunction. Echocardiography 29:647–651CrossRefPubMed

21.

Mehta SK, Richards N, Lorber R et al (2009) Abdominal obesity, waist circumference, body mass index, and echocardiographic measures in children and adolescents. Congenit Heart Dis 4:338–347CrossRefPubMed

22.

Hao PP, Chen YG, Liu YP et al (2013) Association of plasma angiotensin-(1–7) level and left ventricular function in patients with type 2 diabetes mellitus. PLoS One 8:e62788CrossRefPubMedCentralPubMed

23.

Vinereanu D, Madler CF, Gherghinescu C et al (2011) Cumulative impact of cardiovascular risk factors on regional left ventricular function and reserve: progressive long-axis dysfunction with compensatory radial changes. Echocardiography 28:813–820CrossRefPubMed

24.

Marwick TH (2006) Diabetic heart disease. Heart 92:296–300PubMedCentralPubMed

25.

Kaczmarczyk SJ, Andrikopoulos S, Favaloro J et al (2003) Threshold effects of glucose transporter-4 (GLUT4) deficiency on cardiac glucose uptake and development of hypertrophy. J Mol Endocrinol 31:449–459CrossRefPubMed

26.

Sheikh AQ, Hurley JR, Huang W et al (2012) Diabetes alters intracellular calcium transients in cardiac endothelial cells. PLoS One 7:e36840CrossRefPubMedCentralPubMed

27.

Dillmann WH (1989) Diabetes and thyroid-hormone-induced changes in cardiac function and their molecular basis. Annu Rev Med 40:373–394CrossRefPubMed

28.

Connelly KA, Kelly DJ, Zhang Y et al (2009) Inhibition of protein kinase C-beta by ruboxistaurin preserves cardiac function and reduces extracellular matrix production in diabetic cardiomyopathy. Circ Heart Fail 2:129–137CrossRefPubMed

29.

MacGowan GA, Shapiro EP, Azhari H et al (1997) Noninvasive measurement shortening in the fiber and cross-fiber directions in the normal human left ventricle and in idiopathic dilated cardiomyopathy. Circulation 96:535–541CrossRefPubMed

30.

Li CM, Li C, Bai WJ et al (2013) Value of three-dimensional speckle-tracking in detecting left ventricular dysfunction in patients with aortic valvular diseases. J Am Soc Echocardiogr 26:1245–1252CrossRefPubMed

31.

Kissebah AH, Krakower GR (1994) Regional adiposity and morbidity. Physiol Rev 74:761–811PubMed

32.

Huxley R, Mendis S, Zheleznyakov E et al (2010) Body mass index, waist circumference and waist: hip ratio as predictors of cardiovascular risk—a review of the literature. Eur J Clin Nutr 16–22

33.

Mottillo S, Filion KB, Genest J et al (2010) The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol 56:1113–1132CrossRefPubMed

34.

Gong HP, Tan HW, Fang NN et al (2009) Impaired left ventricular systolic and diastolic function in patients with metabolic syndrome as assessed by strain and strain rate imaging. Diabetes Res Clin Pract 83:300–307CrossRefPubMed

35.

Crendal E, Walther G, Vinet A et al (2013) Myocardial deformation and twist mechanics in adults with metabolic syndrome: impact of cumulative metabolic burden. Obesity (Silver Spring) 21:E679–E686

36.

Almeida AL, Teixido-Tura G, Choi EY et al (2014) Metabolic syndrome, strain, and reduced myocardial function: multi-ethnic study of atherosclerosis. Arq Bras Cardiol 102:327–335PubMedCentralPubMed

37.

Tadic M, Cuspidi C, Majstorovic A et al (2014) Does the metabolic syndrome impact left-ventricular mechanics? A two-dimensional speckle tracking study. J Hypertens 32:1870–1878CrossRefPubMed

Titel: Subclinical impairment of left ventricular function in diabetic patients with or without obesity
A study based on three-dimensional speckle tracking echocardiography
verfasst von: Q. Wang
Y. Gao
K. Tan
P. Li
Publikationsdatum: 01.05.2015
Verlag: Urban & Vogel
Erschienen in: Herz / Ausgabe Sonderheft 3/2015
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-014-4186-y

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Subclinical impairment of left ventricular function in diabetic patients with or without obesity

A study based on three-dimensional speckle tracking echocardiography

Abstract