Layer-specific deformation of the left ventricle in uncomplicated patients with type 2 diabetes and arterial hypertension

Tadić, Marijana; Cuspidi, Cesare; Vukomanovic, Vladan; Ilić, Sanja; Obert, Philippe; Kocijancic, Vesna; Ćelić, Vera

doi:10.1016/j.acvd.2017.01.014

Cited by 33 publications

(37 citation statements)

References 28 publications

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“…In our study, the endo‐ and mid‐myocardial layers were more affected than the epicardial layer of the LV in patients with CSFP, which implies that myocardial injury of the LV spread from the endocardium to the epicardium. These findings correspond with those of previous studies regarding three‐layer GLS of the LV in patients with diabetes, aortic stenosis, and heterozygous familial hypercholesterolemia . Moreover, considering that three‐layer LV‐GLS plays an important role in predicting cardiovascular events, our study suggested that LV‐GLS‐endo was the most sensitive indicator in identifying subclinical myocardial systolic dysfunction in patients with CSFP.…”

Section: Discussionsupporting

confidence: 91%

“…These findings correspond with those of previous studies regarding threelayer GLS of the LV in patients with diabetes, aortic stenosis, and heterozygous familial hypercholesterolemia. [27][28][29] Moreover, considering that three-layer LV-GLS plays an important role in predicting cardiovascular events, 30 our study suggested that LV-GLS-endo was the most sensitive indicator in identifying subclinical myocardial systolic dysfunction in patients with CSFP.…”

Section: Discussionmentioning

confidence: 75%

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Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography

et al. 2018

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Objective This study aimed to determine whether STE could help detect subclinical myocardial dysfunction in patients with CSFP. Methods Sixty patients with CSFP confirmed by CAG and 51 controls with normal coronary flow were prospectively enrolled. Coronary angiographic data and conventional and speckle tracking echocardiographic parameters of the LV and RV were obtained for every subject. Results Compared with controls, CSFP patients presented with higher BMI and TG levels, but lower HDL‐C levels. Conventional echocardiographic parameters of biventricular systolic and diastolic function did not differ between the two groups (all P > 0.05). The GLS of the LV and RV was significantly impaired in CSFP patients compared with that in controls (−19.03% vs −21.42%, P < 0.001 and −19.72% vs −22.96%, P = 0.001, respectively). The myocardial impairment pattern of CSFP patients was homogenous in the RV and heterogeneous in the LV, where only endo‐ and mid‐myocardial layers were affected. LV‐GLS and RV‐GLS were found to be well correlated with mTFC and HDL‐C in CSFP groups (r = 0.463 vs r = 0.439; r = −0.569 vs r = −0.552, all P < 0.05). ROC curve analysis demonstrated that LV‐GLS‐endo had the highest AUC (0.867, P < 0.001) for predicting subclinical myocardial impairment in CSFP patients. Conclusions Subclinical myocardial systolic dysfunction occurs in both ventricles, and GLS could be an effective method to detect early‐stage myocardial impairment in patients with CSFP.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 75%

Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography

et al. 2018

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“…Investigations showed that patients with prehypertension, white‐coat hypertension, and masked hypertension also had significantly reduced multidirectional LV strain in comparison with normotensive controls . All studies agreed that blood pressure level correlated well with LV multidirectional strain and the strongest correlation was found for LV longitudinal strain. It was demonstrated that LV strain correlated well with blood pressure level independently of LV hypertrophy, LV diastolic function, body mass index, and age.…”

mentioning

confidence: 70%

“…Investigations confirmed that LV mechanics, and primarily longitudinal strain, was impaired in AH patients . The spectrum of patients with AH in the published studies was wider each year, and effect of common comorbidities such as obesity, diabetes, and metabolic syndrome on LV strain was stronger in AH patients than in patients with isolated AH, diabetes, or obesity . This showed that these risk factors had more synergistic negative effect than simple additive effect.…”

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confidence: 76%

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Left ventricular strain and arterial hypertension: Is longitudinal strain ready for primetime?

Tadić

Cuspidi

2020

J of Clinical Hypertension

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More than one decade passed from the first studies regarding left ventricular (LV) mechanics in patients with arterial hypertension (AH). At the beginning, the assessment of LV strain was considered as a research tool, which was exclusively used in well-equipped echocardiographic laboratories. What is the situation nowadays and does LV strain still has status of "fancy gadget" or necessity in the evaluation of subclinical subtle cardiac damage in patients with AH?The first studies used tissue-Doppler derived LV strain and soon after speckle tracking imaging arrived and completely replaced tissue-Doppler strain technique. Pioneer investigations showed difference between physiological LV hypertrophy in athletes and pathological LV hypertrophy in AH patients using LV longitudinal strain. 1,2 However, studies that revealed LV strain deterioration in the young untreated hypertensive patients without LV hypertrophy broke the prejudice that LV hypertrophy is "conditio sine qua non" for LV strain reduction. 3The most of studies emphasized the effect of AH on LV longitudinal strain and impairment of LV circumferential and radial strains, if detected, was put aside. There are several reasons for this attitude of investigators. Namely, strain evaluation is unfortunately still vendor-dependent and this remains the most important limitation of this imaging technique for more than decade. A lot of effort was put in the attempt to establish similar kind of LV longitudinal strain calculation with different vendors, and nowadays, this difference is minimized, but still exists. 4 We are still far a way of establishing the same consensus in calculation of LV circumferential and radial strain. The other important reason that may explain focusing on LV longitudinal strain was the fact that most of vendors provided quick assessment only of LV longitudinal strain, whereas the evaluation of circumferential and radial strains required special software and therefore remained more scientific than clinical tool. The major problem was also setting proper cutoff values for all types of LV strain. This problem was almost overcome for LV longitudinal strain in the last couple of years, and current guidelines claimed that LV longitudinal strain should be >−20% in healthy persons. 5 However, the recommendation still considers −16% as the cutoff of normality. 5This only confirms uncertainty that still exists in this area and large gray zone of LV longitudinal strain (between −16% and −20%). We are not even close to make this kind of consensus for LV circumferential and radial strain. However, one thing is certain, when LV longitudinal strain assessment is made using the same vendor or software from the time of diagnosis through the whole follow-up, one could be certain that evaluation of strain is much more reproducible than calculation of LV ejection fraction over this period. 6 According to the physiological mechanics of LV systolic function, longitudinal dysfunction may serve as a marker at an early stage of myocardial damage, whereas the chang...

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Subclinical systolic dysfunction detected by 2D speckle tracking echocardiography in adults with diabetes mellitus: systematic review and meta-analysis of 6668 individuals with diabetes mellitus and 7218 controls

Ghoreyshi-Hefzabad

Jeyaprakash

et al. 2023

Int J Cardiovasc Imaging

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Purpose Speckle tracking echocardiography (STE) can help to identify subclinical features of diabetic cardiomyopathy (DCM). There is, however, significant heterogeneity in the reported strain values in literature. We performed a systematic review and meta-analysis to compare cardiac systolic strain values assessed by 2D-STE in asymptomatic adults with diabetes mellitus (DM) and healthy controls. Methods Five databases were searched, and a total of 41 valid studies (6668 individuals with DM and 7218 controls) were included for analysis. Pooled mean in each group and mean difference (MD) for left ventricular global longitudinal strain (LVGLS), LV global circumferential strain (LVGCS), LV global radial strain (LVGRS), LV longitudinal systolic strain rate (LVSR), left atrial reservoir strain (LARS) and right ventricular GLS (RVGLS) were assessed. Results Patients with DM had overall 2 units lower LVGLS than healthy subjects 17.5% [16.8, 18.3], vs 19.5 [18.7, 20.4], MD = − 1.96 [− 2.27, − 1.64]. Other strain values were also lower in patients with DM: LVGCS (MD = − 0.89 [− 1.26, − 0.51]); LVGRS (MD = − 5.03 [− 7.18, − 2.87]); LVSR (MD = − 0.06 [− 0.10, − 0.03]); LARS (MD = − 8.41 [− 11.5, − 5.33]); and RVGLS (MD = − 2.41 [− 3.60, − 1.22]). Meta-regression identified higher body mass index (BMI) as the single contributor to worse LVGLS, LVGCS and LVSR. Those with higher Hemoglobulin A1c had worse RVGLS. Conclusion Myocardial strains were reduced in whole heart in patients with DM. The largest reduction was observed in LA reservoir strain, followed by RVGLS and LVGLS. Higher BMI in patients with DM is associated with worse LV strain values.

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Layer-specific deformation of the left ventricle in uncomplicated patients with type 2 diabetes and arterial hypertension

Cited by 33 publications

References 28 publications

Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography

Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography

Left ventricular strain and arterial hypertension: Is longitudinal strain ready for primetime?

Subclinical systolic dysfunction detected by 2D speckle tracking echocardiography in adults with diabetes mellitus: systematic review and meta-analysis of 6668 individuals with diabetes mellitus and 7218 controls

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