nach oben

Erschienen in:

01.05.2015 | Original article

Subclinical left ventricular systolic dysfunction in diabetic patients and its association with retinopathy

A 2D speckle tracking echocardiography study

verfasst von: A. Karagöz, T. Bezgin, I. Kutlutürk, S. Külahçıoğlu, I.H. Tanboğa, A. Güler, C.Y. Karabay, V. Oduncu, H. Aksoy, C. Kırma

Erschienen in: Herz | Sonderheft 3/2015

Einloggen, um Zugang zu erhalten

Abstract

Aim

It is important to diagnose diabetic cardiomyopathy in the early stages to prevent development of evident heart failure in the future. The primary objective of this study was to evaluate the presence of subclinical left ventricular (LV) dysfunction with two-dimensional (2D) speckle tracking echocardiography (STE) and the secondary objective was to compare retinopathy-positive and -negative diabetic patients.

Patients and methods

A total of 82 patients with type II diabetes mellitus (DM) and 90 gender-matched healthy controls were included. Retinopathy was present in 55 patients in the study group. All study participants underwent conventional 2D echocardiography and STE.

Results

All diabetic patients had preserved LV ejection fraction (LV-EF ≥ 50). Compared with the control group, diabetic patients had a larger left atrium (47.3 ± 19.9 mm vs. 36.9 ± 17.8 mm, p < 0.001) and a higher E/Em ratio (12.0 ± 2.9 vs. 10.5 ± 3.7, p = 0.004). The LV-EF, LV end diastolic and end systolic volumes, E/A ratios, deceleration times, and tissue Doppler parameters were compared between groups. The study group was observed to have statistically significant lower four-chamber (4C; 17.7 ± 3.0 % vs. 19.3 ± 3.5 %, p = 0.002), three-chamber (3C; 17.5 ± 3.0 % vs. 19.2 ± 3.4 %, p = 0.001), and two-chamber (2C; 18.5 ± 3.5 % vs. 20.1 ± 2.4 %, p = 0.001) peak longitudinal strain values compared with the control group. Moreover, LV global strain values were found to be significantly lower in the DM group than in the control group (17.9 ± 2.7 % vs. 21.1 ± 3.2 %, p < 0.001). By contrast, basal rotation (4.9 ± 3.3° vs.2.8 ± 4.5°, p = 0.001), apical rotation (15.3 ± 6.7° vs. 12.1 ± 5.3°, p = 0.001) and LV twist (20.2 ± 7.2° vs. 16.9 ± 6.5°, p = 0.002) in the DM group were significantly increased compared with those of controls.

Conclusion

The STE procedure can be a useful novel technique in the determination of subclinical LV dysfunction in diabetic patients. Diabetic patients have lower longitudinal myocardial mechanics, and circumferential and rotational mechanics are impaired. There was no significant association between diabetic retinopathy and LV function.

Kannel WB, McGee DL (1979) Diabetes and cardiovascular disease. The Framingham study. JAMA 241(19):2035–2038CrossRefPubMed

Maisch B, Alter P, Pankuweit S (2011) Diabetic cardiomyopathy-fact or fiction. Herz 36:102–115CrossRefPubMed

Maisch B, Rupp H (2006) Myocardial fibrosis: a cardiopathophysiologic Janus head. Herz 31(3):260–268CrossRefPubMed

Maisch B (2006) Obesity, diabetes mellitus and metabolic syndrome: the implications for heart and the vascular system. Herz 31(3):185–188CrossRefPubMed

Fang ZY, Prins JB, Marwick TH (2004) Diabetic cardiomyopathy: evidence, mechanisms, and therapeutic implications. Endocr Rev 25(4):543–567CrossRefPubMed

Aneja A, Tang WH, Bansilal S et al (2008) Diabetic cardiomyopathy: insights into pathogenesis, diagnostic challenges, and therapeutic options. Am J Med 121(9):748–757CrossRefPubMed

Heimdal A, Støylen A, Torp H, Skjaerpe T (1998) Real-time strain rate imaging of the left ventricle by ultrasound. J Am Soc Echocardiogr 11(11):1013–1019CrossRefPubMed

Leitman M, Lysyansky P, Sidenko S et al (2004) Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr 17(10):1021–1029CrossRefPubMed

Reisner SA, Lysyansky P, Agmon Y et al (2004) Global longitudinal strain: a novel index of left ventricular systolic function. J Am Soc Echocardiogr 17(6):630–633CrossRefPubMed

10.

Marwick TH (2006) Measurement of strain and strain rate by echocardiography: ready for prime time? J Am Coll Cardiol 47(7):1313–1327CrossRefPubMed

11.

Sivaprasad S, Gupta B, Crosby-Nwaobi R, Evans J (2012) Prevalence of diabetic retinopathy in various ethnic groups: a worldwide perspective. Surv Ophthalmol 57(4):347–370CrossRefPubMed

12.

Early Treatment Diabetic Retinopathy Study Research Group (1991) Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology 98(5 Suppl):786–806CrossRef

13.

Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification. J Am Soc Echocardiogr 18:1440–1463CrossRefPubMed

14.

Mor-Avi V, Lang RM, Badano LP et al (2011) Current and evolving echocardiographictechniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society Of Echocardiography. J Am Soc Echocardiogr 24:277–313CrossRefPubMed

15.

Bell DS (2007) Heart failure in the diabetic patient. Cardiol Clin 25(4):523–538 (vi)CrossRefPubMed

16.

Redfield MM, Jacobsen SJ, Burnett JC Jr et al (2003) Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 289(2):194–202CrossRefPubMed

17.

Galderisi M (2006) Diastolic dysfunction and diabetic cardiomyopathy: evaluation by Doppler echocardiography. J Am Coll Cardiol 48(8):1548–1551CrossRefPubMed

18.

Poirier P, Bogaty P, Garneau C et al (2001) Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes: importance of maneuvers in echocardiographic screening for preclinical diabetic cardiomyopathy. Diabetes Care 24(1):5–10CrossRefPubMed

19.

Patil VC, Patil HV, Shah KB et al (2011) Diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function. Cardiovasc Dis Res 2(4):213–222. doi:10.4103/0975-3583.89805CrossRef

20.

Mishra TK, Rath PK, Mohanty NK, Mishra SK (2008) Left ventricular systolic and diastolic dysfunction and their relationship with microvascular complications in normotensive, asymptomatic patients with type 2 diabetes mellitus. Indian Heart J 60(6):548–553PubMed

21.

Sanderson JE, Fraser AG (2006) Systolic dysfunction in heart failure with a normal ejection fraction: echo-Doppler measurements. Prog Cardiovasc Dis 49(3):196–206CrossRefPubMed

22.

Fang ZY, Yuda S, Anderson V et al (2003) Echocardiographic detection of early diabetic myocardial disease. J Am Coll Cardiol 41(4):611–617CrossRefPubMed

23.

Andersen NH, Poulsen SH, Eiskjaer H et al (2003) Decreased left ventricular longitudinal contraction in normotensive and normoalbuminuric patients with Type II diabetes mellitus: a Doppler tissue tracking and strain rate echocardiography study. Clin Sci (Lond) 105(1):59–66CrossRef

24.

Ha JW, Lee HC, Kang ES et al (2007) Abnormal left ventricular longitudinal functional reserve in patients with diabetes mellitus: implication for detecting subclinical myocardial dysfunction using exercise tissue Doppler echocardiography. Heart 93(12):1571–1576CrossRefPubMedCentralPubMed

25.

Thomas G (2007) Response to “non-Doppler two-dimensional strain imaging by echocardiography-from technical considerations to clinical applications”. J Am Soc Echocardiogr 20(8):1020CrossRefPubMed

26.

Dandel M, Hetzer R (2009) Echocardiographic strain and strain rate imaging—clinical applications. Int J Cardiol 132(1):11–24CrossRefPubMed

27.

Dalen H, Thorstensen A, Aase SA et al (2010) Segmental and global longitudinal strain and strain rate based on echocardiography of 1266 healthy individuals: the HUNT study in Norway. Eur J Echocardiogr 11(2):176–183CrossRefPubMed

28.

Belghitia H, Brette S, Lafitte S et al (2008) Automated function imaging: a new operator-independent strain method for assessing left ventricular function. Arch Cardiovasc Dis 101(3):163–169CrossRefPubMed

29.

Sengupta PP, Krishnamoorthy VK, Korinek J et al (2007) Left ventricular form and function revisited: applied translational science to cardiovascular ultrasound imaging. J Am Soc Echocardiogr 20(5):539–551CrossRefPubMedCentralPubMed

30.

Park SJ, Miyazaki C, Bruce CJ et al (2008) Left ventricular torsion by two-dimensional speckle tracking echocardiography in patients with diastolic dysfunction and normal ejection fraction. J Am Soc Echocardiogr 21(10):1129–1137CrossRefPubMed

31.

Støylen A, Slørdahl S, Skjelvan GK et al (2001) Strain rate imaging in normal and reduced diastolic function: comparison with pulsed Doppler tissue imaging of the mitral annulus. J Am Soc Echocardiogr 14(4):264–274CrossRefPubMed

32.

Lee R, Hanekom L, Marwick TH et al (2004) Prediction of subclinical left ventricular dysfunction with strain rate imaging in patients with asymptomatic severe mitral regurgitation. Am J Cardiol 94(10):1333–1337CrossRefPubMed

33.

Marciniak A, Sutherland GR, Marciniak M et al (2009) Myocardial deformation abnormalities in patients with aortic regurgitation: a strain rate imaging study. Eur J Echocardiogr 10(1):112–119CrossRefPubMed

34.

Dogan S, Aydin M, Gursurer M et al (2006) Prediction of subclinical left ventricular dysfunction with strain rate imaging in patients with mild to moderate rheumatic mitral stenosis. J Am Soc Echocardiogr 19(3):243–248CrossRefPubMed

35.

Davidavicius G, Kowalski M, Williams RI et al (2003) Can regional strain and strain rate measurement be performed during both dobutamine and exercise echocardiography, and do regional deformation responses differ with different forms of stress testing? J Am Soc Echocardiogr 16(4):299–308CrossRefPubMed

36.

Voigt JU, Exner B, Schmiedehausen K et al (2003) Strain-rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia. Circulation 107(16):2120–2126CrossRefPubMed

37.

Chow PC, Liang XC, Cheung EW et al (2008) New two-dimensional global longitudinal strain and strain rate imaging for assessment of systemic right ventricular function. Heart 94(7):855–859CrossRefPubMed

38.

Thomas L, McKay T, Byth K, Marwick TH (2007) Abnormalities of left atrial function after cardioversion: an atrial strain rate study. Heart 93(1):89–95CrossRefPubMedCentralPubMed

39.

Cognet T, Vervueren PL, Dercle L et al (2013) New concept of myocardial longitudinal strain reserve assessed by a dipyridamole infusion using 2D-strain echocardiography: the impact of diabetes and age, and the prognostic value. Cardiovasc Diabetol 12:84CrossRefPubMedCentralPubMed

40.

Fang ZY, Leano R, Marwick TH (2004) Relationship between longitudinal and radial contractility in subclinical diabetic heart disease. Clin Sci (Lond) 106(1):53–60CrossRef

41.

Ernande L, Rietzschel ER, Bergerot C et al (2010) Impaired myocardial radial function in asymptomatic patients with type 2 diabetes mellitus: a speckle-tracking imaging study. J Am Soc Echocardiogr 23(12):1266–1272CrossRefPubMed

42.

Ernande L, Bergerot C, Rietzschel ER et al (2011) Diastolic dysfunction in patients with type 2 diabetes mellitus: is it really the first marker of diabetic cardiomyopathy? J Am Soc Echocardiogr 24(11):1268–1275.e1CrossRefPubMed

43.

Ng AC, Delgado V, Bertini M et al (2009) Findings from left ventricular strain and strain rate imaging in asymptomatic patients with type 2 diabetes mellitus. Am J Cardiol 104(10):1398–1401CrossRefPubMed

44.

Greenbaum RA, Ho SY, Gibson DG et al (1981) Left ventricular fibre architecture in man. Br Heart J 45(3):248–263CrossRefPubMedCentralPubMed

45.

Hiramatsu K, Ohara N, Shigematsu S et al (1992) Left ventricular filling abnormalities in non-insulin-dependent diabetes mellitus and improvement by a short-term glycemic control. Am J Cardiol 70(13):1185–1189CrossRefPubMed

46.

Fein FS (1990) Diabetic cardiomyopathy. Diabetes Care 13(11):1169–1179CrossRefPubMed

47.

Bertoni AG, Tsai A, Kasper EK, Brancati FL (2003) Diabetes and idiopathic cardiomyopathy: a nationwide case-control study. Diabetes Care 26(10):2791–2795CrossRefPubMed

48.

Fava S, Azzopardi J, Muscat HA, Fenech FF (1993) Factors that influence outcome in diabetic subjects with myocardial infarction. Diabetes Care 16(12):1615–1618CrossRefPubMed

49.

Kurioka S, Ose H, Fukuma K, Yoshimoto K (2013) Severity of diabetic retinopathy is associated with left ventricular diastolic dysfunction in patients with type 2 diabetes. Diabetes Res Clin Pract 99(3):287–291. doi:10.1016/j.diabres.2012.12.021 (Epub 2013 Jan 29)CrossRefPubMed

50.

Takeda Y, Sakata Y, Mano T et al (2011) Diabetic retinopathy is associated with impaired left ventricular relaxation. J Card Fail 17(7):556–560. doi:10.1016/j.cardfail.2011.03.007 (Epub 2011 Apr 22)CrossRefPubMed

Titel: Subclinical left ventricular systolic dysfunction in diabetic patients and its association with retinopathy
A 2D speckle tracking echocardiography study
verfasst von: A. Karagöz
T. Bezgin
I. Kutlutürk
S. Külahçıoğlu
I.H. Tanboğa
A. Güler
C.Y. Karabay
V. Oduncu
H. Aksoy
C. Kırma
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/s00059-014-4138-6

Neu im Fachgebiet Kardiologie

19.04.2024 | Vorhofflimmern | Nachrichten

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Subclinical left ventricular systolic dysfunction in diabetic patients and its association with retinopathy

A 2D speckle tracking echocardiography study

Abstract

Aim

Patients and methods

Results

Conclusion

Neu im Fachgebiet Kardiologie

Parodontalbehandlung verbessert Prognose bei Katheterablation

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Sind Betablocker auch für ältere herzschwache Personen nützlich?

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Kardiologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Aim

Patients and methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Sonderheft 3/2015

ECG-gated coronary angiography enables submillisievert imaging in invasive cardiology

Evaluation of adiponectin and lipoprotein(a) levels in cardiac syndrome X

Nonbacterial endocarditis presenting as a right ventricular tumor in assumed Behçet’s disease

Transesophageal echocardiographic evaluation of a giant intracardiac mass originating from the left superior pulmonary vein

Predictive value of visceral adiposity index for type 2 diabetes mellitus

Epicardial adipose tissue thickness, flow-mediated dilatation of the brachial artery, and carotid intima–media thickness

Neu im Fachgebiet Kardiologie

Parodontalbehandlung verbessert Prognose bei Katheterablation

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Sind Betablocker auch für ältere herzschwache Personen nützlich?

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Kardiologie