Diabetic microvascular complications are associated with reduced global longitudinal strain independent of atherosclerotic coronary artery disease in asymptomatic patients with diabetes mellitus: a cross-sectional study

Abstract

Background Reduced left ventricular function, assessed by global longitudinal strain (GLS), is sometimes observed in asymptomatic patients with diabetes mellitus (DM) and is often present in patients with diabetes-related microvascular complications. Our aim was to assess the association between microvascular complications, coronary artery plaque burden (PB) and GLS in asymptomatic patients with DM and non-obstructive coronary artery disease (CAD). Methods This cross-sectional study included patients with DM without any history, symptoms or objective evidence of obstructive CAD. All patients were identified in the outpatient Clinic of Endocrinology at Odense University Hospital Svendborg. An echocardiography and a coronary computed tomography angiography were performed to assess GLS and the degree of CAD, respectively. A coronary artery stenosis < 50% was considered non-obstructive. A linear regression model was used to evaluate the impact of potential confounders on GLS with adjustment of body mass index (BMI), mean arterial pressure (MAP), microvascular complications, type of diabetes, tissue Doppler average early diastolic mitral annulus velocity (e’) and PB. Results Two hundred and twenty-two patients were included, of whom 172 (77%) had type 2 DM and 50 (23%) had type 1 diabetes. One hundred and eleven (50%) patients had microvascular complications. GLS decreased as the burden of microvascular complications increased (P-trend = 0.01): no microvascular complications, GLS (− 16.4 ± 2.5%), 1 microvascular complication (− 16.0 ± 2.5%) and 2–3 microvascular complications (− 14.9 ± 2.8%). The reduction in GLS remained significant after multivariable adjustment (β 0.50 [95% CI 0.11–0.88], p = 0.01). BMI (β 0.12 [95% CI 0.05–0.19]) and MAP (β 0.05 [95% CI 0.01–0.08]) were associated with reduced GLS. In addition, an increased number of microvascular complications was associated with increased PB (β 2.97 [95% CI 0.42–5.51], p = 0.02) in a univariable linear regression model, whereas there was no significant association between PB and GLS. Conclusions The burden of microvascular complications was associated with reduced GLS independent of other cardiovascular risk factors in asymptomatic patients with DM and non-obstructive CAD. In addition, the burden of microvascular complications was associated with increasing PB, whereas PB was not associated with GLS.

Assessment of subclinical left ventricular systolic dysfunction in patients with type 2 diabetes: Relationship with HbA1c and microvascular complications

“…A cross‐sectional study including 82 T2DM patients demonstrated that GLS was free from the impacts of retinopathy 29 . Similarly, Pararajasingam et al also pointed out that none of the subgroups of retinopathies had a relation to GLS 30 . However, increasing studies demonstrated the prominent relation of the diabetic retinopathy to the impaired LV systolic function as evaluated by GLS <18% 31,32 .…”

The Effect of Clinically Indicated Liraglutide on Pericoronary Adipose Tissue in Type 2 Diabetic Patients

“…Data for the current study was derived from a previous prospective observational single-center study performed at Odense University Hospital, Svendborg, Denmark, from March 2016 to September 2018 [32,33]. The primary aim of the original study was to investigate the changes in plaque burden and composition in T2DM.…”

Effects of 3 months of treatment with empagliflozin on left ventricle global longitudinal strain and myocardial mechano‐energetic effiency

“…It is now included in routine evaluation, especially for patients who receive cardiotoxic chemotherapy 6 . GLS was also found to be associated with cardiovascular events in DM patients who do not have a history of cardiovascular complications 7 …”

“…6 GLS was also found to be associated with cardiovascular events in DM patients who do not have a history of cardiovascular complications. 7 The myocardial mechano-energetic efficiency (MME) method has been used in recent years to provide important information on the structure, functions, and oxygen consumption of the myocardium. It has come to the forefront as an effective method in predicting preclinical cardiovascular events.…”