Early detection of left ventricular dysfunction in diabetes mellitus patients with normal ejection fraction, stratified by BMI: A preliminary speckle tracking echocardiography study

Abstract

Background:Diabetes mellitus (DM) represents by itself a major risk factor for cardiovascular events and the coexistence of obesity with consequent left ventricular volumetric overload could be responsible for further damages on left ventricular function. Aim of this study was to demonstrate the effect of body mass index (BMI) on left ventricular function in diabetes patients with no cardiovascular complications and with normal ejection fraction (EF).Materials and Methods:We evaluated 71 stable asymptomatic diabetes patients in optimal medical treatment and 24 healthy controls (C) (45% females; mean age: 58.4 +/− 9.4 years; BMI: 23.5 +/− 1.5). We stratified diabetes patients into two groups according to BMI: BMI <30 kg/m2 (A: 44 patients; 47% females; mean age: 60.9 +/− 6.6 years; BMI: 25.7 +/− 1.9; Diabetes duration: 9.1 +/− 9.5 years); BMI >30 kg/m2 (B: 27 patients; 37% females; mean age: 56.2 +/− 7.8 years; BMI: 33.0 +/− 2.1; Diabetes duration: 8.5 +/− 5.2 years). The following parameters were evaluated by conventional two dimensional (2D) echocardiography (GE VIVID 7) and tissue Doppler imaging (TDI): left ventricular dimensions (LVIDd; PWTd; IVSd), Left Ventricular Volumes (EDV, ESV), EF (by biplane Simpson’s method), Left Ventricular Mass (by ASE formula), peak mitral annular velocity at septal and lateral levels (Sm and Sl). Global longitudinal strain (GLS) was obtained off line by Speckle tracking imaging method using Echopac 10 software.Results:Groups A, B were comparable for diabetes duration and glycated hemoglobin level, history of hypertension, and lipid profile. The EF was similar in the three groups, (A: 64 +/− 6%; B: 63 +/− 4%; C: 61 +/−5%; P= NS). LVMass2.7 indexed for height was significantly higher in A and B in comparison with C (A: 45.2 +/− 8.1 g/m2.7; B: 46.1 +/− 9.6 g/m2.7; C: 39.5 +/− 4.9 g/m2.7; P < 0.05). The stroke volume index (SVi) was significantly lower in B vs A (B: 35.3 +/− 5.7 ml/m2; A: 39.3 +/7.1 ml/m2; P = 0.033). GLS was significantly lower in group B respect A and C (C: 20.9 +/− 1.3%; A: -20.3+/−2.6%; B: -19 +/− 2; P < 0.05; P < 0.01).Conclusions:In uncomplicated asymptomatic DM patients, the presence of first degree obesity plays an incremental role in adversely affecting left ventricular function and remodeling. The conventional echocardiographic methods such as the EF and the TDI are not so sensitive to identify the early LV dysfunction such as the evaluation of GLS by Speckle Tracking echocardiography. The longitudinal subendocardial fibers dysfunction in diabetes/obese patients could be derived by the complex interaction between metabolic (diabetes) and hemodynamic/endocrine abnormalities.

Diagnostic Accuracy of Strain Imaging of the Left Ventricle in Detection of Obstructive Coronary Artery Disease

“…Our results found no statistically significant difference between the three groups as regarding demographic data and risk factors. This was contrary to Conte L. et al [6] who measured the degree of longitudinal fibers dysfunction by STE in diabetic and obese patients and found reduction in GLPS in those patients. Also, Rostamzadeh et al stated that of conventional risk factors, diabetes mellitus (55%) and hypertension (67%) were more frequent in the high-risk group when compared with low-risk and normal groups [1].…”

The association of left ventricular mass index with metabolic syndrome in comparison to hypertensive patients

“…The longitudinal subendocardial fibers dysfunction in diabetes/obese patients could be derived by the complex interaction between metabolic (diabetes) and hemodynamic/endocrine abnormalities. [18] In the present study, hyperglycemia has shown to increase the LVMI since MS patients with mean FBS ≤ 140 mg/dl had highest mean LVMI (53.72 ± 27.91 g/m 2.7 ) than hypertensive patients (40.48 ± 14.13 g/m 2.7 ) [Table 3]. Grossman et al .…”

“…After the load is elevated due to elevated vascular resistance caused by excess adipose tissue and higher artery stiffness. [18] This study has showed that high BMI increases LVMI since MS patients with BMI > 30 had highest mean LVMI (51.14 ± 22.08 g/m 2.7 ) than MS patients with BMI < 30 had least (38.35 ± 8.52 g/m 2.7 ) [Table 3]. Schirmer et al .…”

Echocardiography, an Indispensable Tool for the Management of Diabetics, with or without Coronary Artery Disease, in Clinical Practice

“…After studying diabetic patients with a free history of cardiovascular disease and with preserved ejection fraction, researchers concluded that increased body weight induced subclinical alteration in longitudinal deformation, precisely detected by STE. As a result, we notice that while DM causes a subtle and global deterioration in cardiac function before symptoms occur, obesity further hampers proper systolic and diastolic function [ 25 ].…”