Subclinical Right Ventricular Dysfunction in Type 2 Diabetes Mellitus: An Echocardiographic Strain/Strain Rate Study

Abstract

Background: Type II Diabetes Mellitus (DM) was accompanied by subclinical impairment of Right Ventricular (RV) systolic dysfunction. Two-Dimensional (2D) Speckle Tracking Echocardiography (STE) allows a precise evaluation of myocardial function. Aim of the Study: The aim of this study was to assess the RV systolic function in asymptomatic normotensive subjects with type II DM compared with control subjects, using strain/ strain rate qualification by 2D STE. Subjects and Methods: Prospective study enrolled 100 subjects, they were classified into two groups: Group I included seventy subjects known to have type II DM (36 males and 34 females), mean age 41.37±4.72 years, and group II included thirty healthy subjects (15 males and 15 females) with mean age 39.40±3.14 years. All subjects had normal Left Ventricular (LV) Ejection Fraction (EF), calculated by conventional 2D Trans-Thoracic Echocardiography (TTE). Subjects who had diseases affecting LV and RV systolic functionwere excluded as hypertension, coronary artery disease, valvular diseases, arrhythmias, pulmonary diseases and pulmonary hypertension. All studied population were subjected to informed verbal consent, full history taking. General and cardiac examination were done. Resting standard 12-leads Electrocardiogram (ECG) has been recorded for analysis. HaemoglobinA1c (HbA1c %) level was measured for group I. 2D TTE and 2D STE were done for all subjects. LV global longitudinal strain (LVGLS%), RVGLS%, RV segmental peak Longitudinal Systolic Strains (LSS%) and RV segmental longitudinal systolic strain rates (LSSRs 1/sec) were assessed by 2D STE. Data were collected and statistically analysed. Results: Both groups showed no statistically significant difference regarding LV linear internal dimensions, EF, LV Mass Index (LVMI), RV inflow linear dimensions, Fractional Area Change (FAC) and Tricuspid Annular Post-Systolic Excursion (TAPSE). Mean values of LVGLS and RVGLS were significantly lower in group I than in group II, as mean values for GLS of LV & RV were (-19.93 ± 1.48,-21.49±3.80

Subclinical right ventricular dysfunction in patients with asymptomatic type 2 diabetes mellitus: A cross-sectional study

“…In our study, there was a significantly higher A velocity in diabetic patients but not an E velocity. In the study conducted by Yaser R. Mohammed et al, 22 they demonstrated the presence of subclinical RV as well as LV dysfunction in diabetes mellitus. A study published in 2020 concluded that prediabetes is associated with structural and functional changes in the right atria and ventricle due to the direct myocardial impact of hyperglycemia.…”

“…Similar subclinical RV as well as LV dysfunction was found in a study published by Waler R Hablas et al in 2018 in Egypt. 22 In a study conducted by Aymen Ahmed et al, 23 indices of RV function, i.e., peak myocardial systolic velocity, early diastolic myocardial velocity, and late diastolic myocardial velocity, as measured by tissue Doppler imaging, were found to be significantly lower in diabetics compared to the control group. A similar result has been obtained in our study, where all four parameters measured through TDI showed significant differences among the diabetic and nondiabetic groups.…”