Échocardiographie à la dobutamine ou étude de la déformation longitudinale au repos pour démasquer une cardiomyopathie diabétique débutante symptomatique ?

Assessment of subclinical diabetic cardiomyopathy by speckle‐tracking imaging

“…In this respect, the authors concluded that systolic dysfunction assessed by systolic strain alteration ‘might be proposed as the first indicator of DCM’ 41 . Several other studies found similar results in both type 1 and type 2 DM patients, which further acknowledge the presence of systolic dysfunction in early stages of DCM 5,8,16,17 …”

“…Subclinical systolic dysfunction was predominantly assessed using 2D STE parameters: GLS was measured in most of the cases, but global circumferential (GCS) and radial (GRS) strains were also measured in some of the included studies 4,7,8,16,21‐25 (Table 1). Furthermore, few studies also used 3D STE 1,7,26 and multiple‐layer strain 5,8,21,27‐30 for systolic function assessment.…”

“…The last years have brought solid evidence with regard to the progression of myocardial dysfunction in patients with DM, several studies showing that diastolic dysfunction might not be the earliest alteration in DCM 5,8,16,17,41 . To that end, a breakthrough was the finding that patients with DM presenting diastolic dysfunction as the earliest sign of DCM were more likely to present other associated cardiovascular risk factors, such as older age, obesity or higher heart rates 14,38,41,42 .…”

“…Most of the studies support the traditional hypothesis that LV diastolic dysfunction is the first cardiac functional alteration in the development of DCM 1‐3,10,14,15 . However, several recent studies suggest that subclinical systolic dysfunction measured by STE may occur ahead of diastolic dysfunction, 5,8,16,17 or at least concomitantly with it 4,7,11,18,19 . Therefore, detecting ventricular dysfunction as early as its subclinical stages could be an important step in order to lower the morbidity and mortality in patients with DM 3 …”