Diastolic Dysfunction in Patients with Type 2 Diabetes Mellitus: Is It Really the First Marker of Diabetic Cardiomyopathy?

Ernande, Laura; Bergerot, Cyrille; Rietzschel, Ernst; Buyzere, Marc L. De; Thibault, Hélène; PignonBlanc, Pierre Gautier; Croisille, Pierre; Ovize, Michel; Groisne, L.; Moulin, Philippe; Gillebert, Thierry C.; Dérumeaux, Geneviève

doi:10.1016/j.echo.2011.07.017

Cited by 201 publications

(168 citation statements)

References 34 publications

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“…Our results are consistent with those of Abdel-Salam et al who demonstrated early impairment of LV longitudinal systolic deformation analyzed by 2D speckle strain in young asymptomatic type 1 diabetic adults without associated comorbidities [29] . The consistency of these results suggests that type 1 diabetes may be associated with early longitudinal strain impairment, which may be the first marker of preclinical diabetic cardiomyopathy, as previously suggested in type 2 diabetes [30,31] . The strain measurements reflect myocardial deformation, but they are also dependent on load conditions, ventricular geometry, and elastic properties of myocardial tissue [24] .…”

Section: Left Ventricular Morphology and Functionsupporting

confidence: 67%

“…These mechanisms include the metabolic abnormalities of cardiomyocytes associated with excessive use of very long chain fatty acids, chronic hyperglycemia, impaired calcium homeostasis, fibrosis, myocyte apoptosis, microcirculation abnormalities, and cardiac autonomic dysfunction [5] . The decrease in longitudinal deformation may reflect structural and functional changes of myocardial fibers due to diabetes through one of these mechanisms, and may constitute the first sign of diabetic cardiomyopathy [31] . A relationship between glycemic control and abnormalities in heart function have been reported in children and adults [33,34] .…”

Section: Potential Mechanismsmentioning

confidence: 99%

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Decreased regional left ventricular myocardial strain in type 1 diabetic children: a first sign of diabetic cardiomyopathy?

Hodžić

Ribault

Maragnès

et al. 2016

Journal of Translational Internal Medicine

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Background and Objectives: Type 1 diabetes is a major cardiovascular risk factor associated with an excess of mortality in young adults due to premature cardiovascular events, which includes heart failure. The relation between type 1 diabetes and cardiac structure and function in children was poorly documented. Our study investigates (1) whether type 1 diabetic children have echocardiographic signs of subclinical cardiac dysfunction assessed by tissue Doppler strain and (2) whether state of metabolic control and diabetes duration have any influence on the cardiac event. Methods: Standard echocardiography and tissue Doppler imaging were prospectively performed in type 1 diabetic children. Left ventricular dimensions, standard indices of systolic and diastolic function, and septal longitudinal strain were investigated. Results: Thirty consecutive asymptomatic diabetic children (age: 12.4 [5-17] years; males: 53%) were compared to 30 age and sex-matched healthy control subjects. Left ventricular mass index and diastolic septal thickness were significantly increased in diabetic children. There was no difference between two groups as regards the left ventricular ejection fraction and conventional mitral Doppler parameters (E, A, Ea). The global longitudinal systolic strain and strain rate were found to be decreased in children with diabetes. The global longitudinal early diastolic strain rate (Esr) was negatively correlated with metabolic control. Longitudinal strain was not correlated with diabetes duration. Conclusion: Children with Type 1 diabetes had subclinical alterations in left ventricular size and longitudinal myocardial deformation.

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Section: Left Ventricular Morphology and Functionsupporting

confidence: 67%

Section: Potential Mechanismsmentioning

confidence: 99%

Decreased regional left ventricular myocardial strain in type 1 diabetic children: a first sign of diabetic cardiomyopathy?

Hodžić

Ribault

Maragnès

et al. 2016

Journal of Translational Internal Medicine

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“…In the current study, we report that the prevalence of systolic longitudinal dysfunction is 50% among community population‐based T2DM‐SAHF and 28% among other‐SAHF. Alterations of systolic strain may exist despite normal diastolic function 22. Importantly, impaired GLS as a marker of SBHF is associated with an increased risk of further transition to symptomatic Stage C HF with preserved EF in diabetes 2.…”

Section: Discussionmentioning

confidence: 99%

Variations in subclinical left ventricular dysfunction, functional capacity, and clinical outcomes in different heart failure aetiologies

Wang¹,

Yang²,

Nolan³

et al. 2018

ESC Heart Failure

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AimsPatients with heart failure (HF) risk factors are described as being in Stage A of this condition (SAHF). Management is directed towards prevention of HF progression, but to date, no evidence has been described to align the intensity of this intervention to HF risk. We sought to what extent SAHF of Type 2 diabetes mellitus (T2DM) and other HF risks showed differences in subclinical left ventricular function, exercise capacity, and prognosis.Methods and resultsWe recruited 551 elder asymptomatic SAHF patients (age 71 ± 5 years, 49% men, 290 T2DM) with at least one risk factor from a community‐based population with preserved ejection fraction. All underwent a comprehensive echocardiogram including global longitudinal strain (GLS) and a 6 min walk test and were followed for 2 years. The primary endpoints were new‐onset HF and all‐cause mortality. The T2DM group was associated with reduced 6 min walk test distance (451 ± 111 vs. 493 ± 87 m, P < 0.001), worse diastolic function (E/e′ 9.2 ± 2.7 vs. 8.7 ± 2.4, P = 0.028), and impaired GLS (−17.7 ± 2.6% vs. −19.0 ± 2.6%, P < 0.001). Over a median follow‐up of 1.6 years, 49 T2DM‐SAHF and 27 other‐SAHF met the primary endpoint. T2DM‐SAHF had significantly worse outcome than other‐SAHF (P = 0.021). In Cox models, obesity [hazard ratio (HR) = 2.46; P = 0.007], atrial fibrillation (HR = 2.39; P = 0.028), 6 min walk distance (HR = 0.99; P = 0.034), and GLS (HR = 1.14; P = 0.033) were independently associated with the primary endpoint in T2DM‐SAHF, independent of age and glycaemic control.ConclusionsThe T2DM‐SAHF has worse subclinical left ventricular function, exercise capacity, and prognosis than other‐SAHF. Impaired GLS, atrial fibrillation, exercise capacity, and obesity are associated with a worse prognosis in T2DM‐SAHF but not in other‐SAHF.

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“…All participants gave written informed consent prior to enrollment. Data collection and measurements have been described previously (18)(19)(20)(21)(22).…”

Section: Study Populationmentioning

confidence: 99%

Thyroid Hormone Levels Within Reference Range Are Associated with Heart Rate, Cardiac Structure, and Function in Middle-Aged Men and Women

Roef

Taes

Kaufman

et al. 2013

Thyroid

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Background: Triiodothyronine (T3) has many effects on the heart, and marked changes in cardiac function and structure occur in patients with (subclinical) thyroid disease. We investigated whether between-subject variation in thyroid hormone levels within the euthyroid range is also associated with heart rate and echocardiographic heart function and structure. Methods: Subjects were selected from the Asklepios study (n = 2524), a population-representative random sample of patients aged between 35 and 55 years, free from overt cardiovascular disease at baseline. Analyses were restricted to 2078 subjects (1013 women and 1065 men), not using antihypertensive or thyroid medication nor having antithyroperoxidase antibody levels above clinical cut-off or thyrotropin (TSH) levels outside the reference range. All subjects were phenotyped in-depth and underwent comprehensive echocardiography, including diastolic evaluation. Thyroid function parameters were determined by automated electrochemiluminescence. Results: Heart rate was robustly positively associated with (quartiles of) free T3 (FT3) and T3, both in subjects with TSH levels within reference (0.27-4.2 lU/L) and in narrow TSH range (0.5-2.5 lU/L; p <0.0001). FT3 and T3 were negatively associated with left ventricular (LV) end-diastolic volume but positively associated with relative wall thickness. Total T3 (TT3) was associated with enhanced ventricular contraction (as assessed by tissue Doppler imaging). Free thyroxine, FT3, and TT3 were positively associated with late ventricular filling, and TT3 was associated with early ventricular filling. Conclusion: We have demonstrated a strong positive association between thyroid hormone levels within the euthyroid range and heart rate, and more subtle effects on cardiac function and structure. More specifically, we suggest a smaller LV cavity size (with increased relative wall thickness), an enhanced atrial and ventricular contraction, and LV relaxation with higher circulating thyroid hormones. These results illustrate that variation in thyroid hormone levels, even within the reference range, exerts effects on the heart.

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Diastolic Dysfunction in Patients with Type 2 Diabetes Mellitus: Is It Really the First Marker of Diabetic Cardiomyopathy?

Cited by 201 publications

References 34 publications

Decreased regional left ventricular myocardial strain in type 1 diabetic children: a first sign of diabetic cardiomyopathy?

Decreased regional left ventricular myocardial strain in type 1 diabetic children: a first sign of diabetic cardiomyopathy?

Variations in subclinical left ventricular dysfunction, functional capacity, and clinical outcomes in different heart failure aetiologies

Thyroid Hormone Levels Within Reference Range Are Associated with Heart Rate, Cardiac Structure, and Function in Middle-Aged Men and Women

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