Role of Strain in the Early Diagnosis of Diabetic Cardiomyopathy

Abstract

Background: Advanced echocardiography using two- and three-dimensional myocardial strain proposes to identify subclinical systolic dysfunction in different clinical conditions. Strain assessment plays an important role in the early diagnosis of diabetic cardiomyopathy in diabetes mellitus (DM). However, the findings of published articles are heterogeneous. Here we conducted a systematic review to analyze the current role of strain assessment in patients with DM. Methods: This systematic review of five databases identified 19 studies that used twodimensional strain and 8 studies that used three-dimensional strain. Results: The studies of two-dimensional strain included 1,774 DM patients (mean age, 57.1 years; median age, 55 years; 47.5% women), while those of three-dimensional strain included 488 DM patients (mean age, 55.7 years; median age, 63 years; 51% women). Global longitudinal strain was the myocardial deformation marker that differed most frequently between the DM and control groups. Conclusion: Myocardial strain imaging by two- and three-dimensional speckle tracking echocardiography allows the identification of subclinical systolic dysfunction in DM patients, and differences become more marked when associated with risk factors and ventricular remodeling.

Assessment of new-onset heart failure prediction in a diabetic population using left ventricular global strain: a prospective cohort study based on UK Biobank

“…Thais et al. summarized totally 27 studies, discovering that using 2D and 3D speckle-tracking echocardiography for measuring myocardial strain effectively detected subclinical systolic dysfunction among patients diagnosed with diabetes ( 33 ). However, their study was limited to studies on cardiomyopathy caused by diabetes, and only compared the differences in strain values between the cardiomyopathy group and the non-myocardial group.…”

Biomarkers and subclinical left ventricular dysfunction in patients with type 2 diabetes without clinical manifestations of cardiovascular diseases

“…Несмотря на то, что выраженного снижения ГПД у пациентов с СД2 не было (-17,6%), данный показатель статистически значимо отличался от такового в контрольной группе, где ГПД была <-18% (-19,9%, p<0,008). Недавно опубликованный систематический обзор продемонстрировал, что визуализация деформации миокарда с помощью двухили трехмерной СТЭ позволяет распознавать систолическую СДЛЖ у пациентов с СД [13]. Более того, когортное исследование с 10-летним наблюдением показало, что СДЛЖ, выявленная с помощью оценки ГПД, является независимым предиктором неблагоприятного прогноза течения СН у половины бессимптомных больных СД2 [14].…”

“…The level of NT-proBNP was significantly higher in the T2D and prediabetes groups compared to the control group, while in all three groups it did not exceed normal values (p<0,001). A higher level of NT-proBNP was associated with hypertension -odds ratio (OR) 3,64 [1,[2][3][4][5][6][7][8][9][10][11][12][13],04] (p=0,005), a decrease in LV ejection fraction -OR 1,25 [1,06-1 ,47] (p=0,007), concentric hypertrophy -OR 4,84 [1,41] (p=0,011) and decreased GLS -OR 1,85 [1,62-2,06] (p=0,005), an increase in the ratio of early and late diastolic transmitral flow (E/A) -OR 0,01 [0,008-0,416] (p=0,024) and isovolumic relaxation time (IVRT) -OR 1,08 [1,03-1,14] (p=0,03). The sensitivity and specificity of NT-proBNP as a test for predicting GLS reduction <-18% were 86 and 27%, respectively.…”

“…Уровень NT-proBNP был статистически значимо выше в группах СД2 и предиабета в сравнении с контролем, при этом во всех трех группах не превышал нормальных значений (p<0,001). Более высокий уровень NT-proBNP ассоциировался с наличием артериальной гипертонии -отношение шансов (ОШ) 3,64 [1,[2][3][4][5][6][7][8][9][10][11][12][13],04] (p=0,005), снижением фракции выброса ЛЖ -ОШ 1,25 [1,06-1,47] (p=0,007), концентрической гипертрофией -ОШ 4,84 [1,41] (p=0,011) и снижением ГПД -ОШ 1,85 [1,62-2,06] (p=0,005), увеличением отношения скоростей трансмитрального потока в раннюю и позднюю диастолу (Е/А) -ОШ 0,01 [0,008-0,416] (p=0,024) и времени изоволюмического расслабления (IVRT) -ОШ 1,08 [1,03-1,14] (p=0,03). Чувствительность и специ-фичность определения NT-proBNP в качестве теста для прогноза снижения ГПД <-18% была 86 и 27%, соответственно.…”

Association Between Left Ventricular Strains and Cardiovascular Risk Factors in Type 2 Diabetic Patients: a Controlled Cross-sectional Study

“…preclinical echocardiography, which is more sensitive than conventional echocardiography ( 28 ). In another systematic review by Silva et al, when conducting data aggregation on 19 studies using 2D STE (1774 patients with diabetes) and 9 studies using 3D STE (488 patients with diabetes), concluded Cardiac deformity imaging by STE 2D and STE 3D is valuable for early identification of preclinical systolic dysfunction, this difference becoming more apparent when combined with risk factors and status ventricular remodeling ( 35 ).…”