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Objective: The purpose of this study was to determine whether resting myocardial deformation and rotation may be altered in diabetic patients with significant epicardial coronary artery disease (CAD) with normal left ventricular ejection fraction.Design: A prospective observational study.Setting: Diagnosis of epicardial CAD in diabetic patients.Patients and Methods: 84 diabetic patients suspected of epicardial CAD scheduled for cardiac catheterization had a resting echocardiogram performed prior to their procedure. Echocardiographic measurements were compared between patients with and without significant epicardial CAD as determined by cardiac catheterization. Main outcome measures:Measurement of longitudinal strain, strain rate, apical rotation and rotation rate, using speckle-tracking echocardiography.Results: 84 patients were studied, 39 (46.4%) of whom had significant epicardial CAD. Global peak systolic apical rotation was significantly increased (14.9±5.1 versus 11.0±4.8 degrees, p<0.001) in patients with epicardial CAD along with faster peak systolic apical rotation rate (90.4±29 versus 68.1±22.2 degrees/sec, p<0.001). These findings were further confirmed through multivariate logistic regression analysis (global peak systolic apical rotation OR=1.17, p=0.004 and peak systolic apical rotation rate OR=1.05, p<0.001). Conclusions:In conclusion, diabetic patients with significant epicardial CAD and normal LVEF exhibit an increase in peak systolic apical counter-clockwise 3 rotation and rotation rate detected by echocardiography suggesting that significant epicardial CAD and its associated myocardial effects in patients with diabetes may be detected non-invasively at rest.

Crohn's disease results in a hypercoagulable state increasing the risk of venous or arterial thromboembolism. Cardiac involvement has not been routinely identified. Two cases are presented to illustrate that patients with Crohn's disease may represent an exception to the rule that left ventricular apical thrombus should be associated with an underlying wall motion abnormality and reduction in left ventricular ejection fraction.

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