BackgroundWhether type 2 diabetes mellitus (DM) in the absence of hypertension (HTA) and coronary artery disease (CAD) affects left ventricular (LV) phenotype and function among asymptomatic DM patients that can be easily discovered in everyday practice, what is the clinical risk profile for diabetic cardiomyopathy and how HTA and CAD modulate LV structure and function above diabetic cardiomyopathy, are still incompletely answered questions.MethodsIn 210 DM patients (group I: 70 asymptomatic DM patients without HTA and CAD; group II: 70 DM patients with HTA and no CAD; group III: 70 DM patients with CAD and no HTA) and 80 healthy individuals, comprehensive echocardiography including speckle tracking strain and strain rate analysis, was done.ResultsCompared to control DM patients without HTA and CAD had increased LV mass, more frequently concentric remodeling, impaired LV relaxation and lower LV ejection fraction (EF), fraction of shortening (FS) and mitral annular plane excursion (MAPSE). Addition of HTA further impaired EF, FS and MAPSE and aggravated diastolic dysfunction, whereas concomitant CAD further impaired FS and MAPSE. Peak global longitudinal strain (Slong) and early diastolic longitudinal strain rate (SRlong E) were impaired in group I compared to control, even when EF was preserved. Peak circumferential strain (Scirc) was impaired only when DM was associated with HTA or CAD. In multivariate analysis DM was significantly and independently from HTA, CAD, age, gender and body mass index associated with: increased LV mass, concentric LV remodeling, lower EF, FS, MAPSE, Slong, SRlongE and distorted diastolic parameters. DM duration, glycosylated hemoglobin, microalbuminuria and retinopathy, were not independent predictors of LV geometry and function.ConclusionDM per se has strong and independent influence on LV phenotype and function that can be detected by conventional and speckle tracking echocardiography in everyday clinical practice, even in asymptomatic patients. We could not confirm that these changes were independently related to duration of DM, quality of metabolic control and presence of microvascular complications. Concomitant HTA or CAD furthermore distorted LV systolic and diastolic function.

Introduction Doppler monitoring of small tissue velocity, can quantify with solid reliability the movement of healthy and diseased myocardium. Strain rate imaging also reflects the tension and degree of myocardial deformation so it can be used as a noninvasive technique to quantify with greater accuracy than tissue Doppler. Objective was to compare the features of tissue Doppler and strain rate imaging in detecting postinfarct changes and assess the sensitivity of each method individually. Methods The study included 35 patients with infarct scar, average age 58.1±10.9 years. All subjects was carried out in addition to conventional ultrasound and tissue Doppler imaging and strain rate on the device Esaote My Lab 30 CV -strain X software package. The evaluation was eprformed in the zone of the scar and the opposite wall of the heart were recorded with a maximum systolic tissue Doppler velocity and the maximum strain / strain in systolic rate. Results The results of tissue Doppler for a myocardial infarction scar was 0.08±0.01 m/sec, while the opposite wall of 0.09±0.02 m/sec (p <0.05). Systolic strain in a myocardial infarction scar area was 16.7±3.9%, while in the area of the opposite wall 18.8±4.0% (p<0.01). Strain rate for the the zone is a heart scar was -0.8±0.21 1/sec, while in the area of the opposite wall of -1. 1±0.25 1/sec (p<0.01). ConclusionTissue Doppler and strain rate can reliably detect the difference of healthy myocardium and scared tissue, with high sensitivity in favor of the strain rate method.

Originalni rad UKS CSSUDRUŽENJE KARDIOLOGA SRBIJE CARDIOLOGy SOCIEty Of SERBIA e hokardiografija je posle EKG-a najčešće korišćena dijagnostička metoda u kardiologiji. Ona igra glavnu ulogu u proceni funkcije leve komore, evaluaciji valvularnih bolesti, kongenitalnih bolesti srca, tromboembolija i ispitivanju prirode bola u grudima. 1Dijastolna disfunkcija (DD) označava smanjenu elastičnost leve komore. Prisustvo DD identifikuje pacijente sa povećanim kardiovaskularnim rizikom. Dijagnoza DD postavlja se invazivnim putem ako se nađe plućni kapilarni pritisak >12 mm Hg i enddijastolni pritisak leve komore > 16 mm Hg.2,3 Prema profilu transmitralnog protoka DD se stepenuje kao: I (blaga), II umerena (pseudonormalizacija), III teška (restriktivno punjenje). 4Hipertenzija predstavlja jedan od najčešćih uzroka DD i glavni činilac u patogenezi nastanka srčane slabosti.5 Poremećena segmentna relaksacija javlja se kao prvi znak strukturnih promena, koje prethode remodelovanju i hipertrofiji leve komore. 6,7 Pacijenti sa hipertenzijom imaju u početnom stadijumu izrazitiju segmentnu DD u bazalnim delovima septuma i inferiornog zida dok je lateralni zid nešto otporniji. Dijastolna disfunkcija vremenom progredira na ostale segmente a globalna disfunkcija postaje merljiva kad bude zahvaćeno više od 50 % segmenata leve komore. 8,9Strain rate imaging je nova ultrazvučna tehnika koja omogućuje procenu regionalne funkcije leve komore u realnom vremenu.10 Strain u svakodnevnom govoru na engleskom jeziku označava "istezanje", dok u naučnom smislu podrazumeva "deformaciju". Miokardni strain (ε) je mera aktuelne deformacije u specifičnoj regiji tkiva , dok je strain rate (SR), jednostavno stepen te deformacije u jedinici vremena. Strain se može izraču- 11,12Početna strain merenja zasnivala su se na tkivnom dopleru (TDI), bila su zavisna od ugla posmatranja i ograničena na merenja longitudinalne i radijalne deformacije. Nova speckle tracking tehnika (praćenja markiranih tačkica) je dvodimenzionalna i omogućuje merenja u cirkumferencijalnoj, radijalnoj i longitudinalnoj ravni. 13,14Primena strain ehokardiografije u evaluaciji hipertenzivnih pacijenata omogućuje napredak u ranoj identifikaciji funkcionalnih abnormalnosti koje se ne mogu detektovati konvencionalnim metodama. 15,16 Redukovani maksimalni strain u pojedinim segmentima miokarda sugeriše da je redukovana deformacija leve komore kao posledica strukturnih promena i ima uticaj na globalnu Uvod: Segmentna dijastolna i sistolna disfunkcija leve komore, uzrokovane hipertenzijom i mogu se pravovremeno dijagnostikovati strain rate imaging ehokardiografijom. Cilj rada je bio da se ispitaju mogućnosti strain imaging ehokardiografije u analizi segmentne sistolne i dijastolne funkcije kod pacijenata sa hipertenzijom. Metode: Ispitivana su 64 pacijenta, 32 novootkrivena hipertoničara sa očuvanom globalnom sistolnom i dijastolnom funkcijom, bez drugih kardioloških oboljenja i 32 zdrave osobe kontrolne grupe. Svim pacijentima rađena je dvodimenzionalna ehokardiografija i strain imaging meto...