Altered myocardial response in patients with diabetic retinopathy: an exercise echocardiography study

Abstract

BackgroundType 2 diabetes mellitus (T2DM) complicated by retinopathy is associated with altered left ventricular (LV) structure and resting myocardial dysfunction unlike T2DM without retinopathy. The myocardial response to stress has not been compared in patients with and without diabetic retinopathy. The aim of this retrospective study was to determine the relationship between retinopathy and myocardial function in patients with T2DM at rest and during exercise echocardiography.Methods134 patients with T2DM and no evidence of underlying coronary artery disease were recruited. All patients underwent retinal photography to screen for diabetic retinopathy, and resting and exercise echocardiography. Resting echocardiography was analyzed by conventional echocardiographic parameters and speckle tracking derived global longitudinal strain (GLS). Exercise echocardiography parameters included diastolic function reserve index (DFRI) and stress GLS.ResultsThe mean age of participants was 60 years and 49 % were male. Diabetic retinopathy was identified in 43 patients (32 %). Resting echocardiography revealed that those with diabetic retinopathy had a higher prevalence of impaired diastolic function, higher E/E′ ratio (LV filling pressures) and impaired resting GLS compared with those without. Exercise echocardiography revealed that those with diabetic retinopathy also had more impaired DFRI and stress GLS. Multivariable analysis showed that the presence of diabetic retinopathy was independently associated with high resting E/E′, diastolic dysfunction grade, impaired resting GLS, low DFRI and impaired stress GLS.ConclusionsIn conclusion, the presence of diabetic retinopathy was independently associated with impaired resting myocardial function (diastolic and systolic function) and myocardial function during stress (evaluated by DFRI and stress GLS).Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-015-0281-5) contains supplementary material, which is available to authorized users.

A randomized controlled trial of the effects of non‐surgical periodontal therapy on cardiac function assessed by echocardiography in type 2 diabetic patients

“…Normally, an E/e' ratio is below 8, while the ratio above 14 may indicate diastolic dysfunction (Nagueh et al., 2016). As most of the E/e' ratio values fall between 8 and 14 in the present study, stressed echocardiography could be a useful adjunct to rest one for better evaluation of the LV diastolic function (Zhen et al., 2015).…”

Retinal vessel diameters and reactivity in diabetes mellitus and/or cardiovascular disease

“…One explanation for this can be found in the fact that only six diabetic patients suffered from DR. Previous work examining retinal vessel calibres, carotid plaque and the impact of exercise on echocardiography parameters all confirmed that patients with DR compared to those suffering from DM without DR or CVD only had a higher risk of adverse CVD events and impaired myocardial function [ 38 – 40 ]. These findings are somewhat unsurprising given that with increasing duration of DM (and age) the prevalence of DR is increasing too, which is reflecting disease progression and a compromised microcirculation which in turn leads to a higher risk of adverse CVD events.…”

Periodontitis links to exacerbation of myocardial dysfunction in subjects with type 2 diabetes

“…Briefly, the DM profile included years of diabetes duration, current treatment modalities, and microvascular complications. Diabetic retinopathy was defined as the presence of microvascular changes in the retina by ophthalmoscopy; and diabetic nephropathy was diagnosed with the presence of proteinuria or microalbuminuria in 24 hours urine sample (≥30 mg); while diabetic neuropathy was identified as the presence of abnormal monofilament test or graded tuning fork test . In addition, hypertension was marked as either resting systolic blood pressure (SBP)/diastolic blood pressure (DBP) ≥ 140/90 mm Hg from at least two separate clinical visits, or usage of antihypertensive drugs.…”

“…involved in alteration of cardiac structure and function in subjects with diabetes. 37 Previous studies have shown that LV systolic function assessed by GLS is significantly associated with microvascular complication, despite the fact that the HbA1C level is comparable between subjects with or without normal LV function 16,27 . Our current findings are in line with the above finding that microvascular complication is significantly associated with GLS.…”