Evolution of subclinical myocardial dysfunction detected by two-dimensional and three-dimensional speckle tracking in asymptomatic type 1 diabetic patients: a long‑term follow-up study

Abstract

BackgroundWe sought to assess the long-term evolution of left ventricular (LV) function using two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography (STE) for the detection of preclinical diabetic cardiomyopathy, in asymptomatic type 1 diabetic patients, over a 6-year follow-up.Design and methodsSixty-six asymptomatic type 1 diabetic patients with no cardiovascular risk factors were compared to 26 matched healthy controls. Conventional, 2D and 3D-STE were performed at baseline. A subgroup of 14 patients underwent a 6-year follow-up evaluation.ResultsAt baseline, diabetic patients had similar LV ejection fraction (60 vs 61%; P = NS), but impaired longitudinal function, as assessed by 2D-global longitudinal strain (GLS) (−18.9 ± 2 vs −20.5 ± 2; P = 0.0002) and 3D-GLS (−17.5 ± 2 vs −19 ± 2; P = 0.003). At follow-up, diabetic patients had worsened longitudinal function compared to baseline (2D-GLS: −18.4 ± 1 vs −19.2 ± 1; P = 0.03). Global circumferential (GCS) and radial (GRS) strains were unchanged at baseline and during follow-up. Metabolic status did not correlate with GLS, whereas GCS and GRS showed a good correlation, suggestive of a compensatory increase of circumferential and radial functions in advanced stages of the disease – long-term diabetes (GCS: −26 ± 3 vs −23.3 ± 3; P = 0.008) and in the presence of microvascular complications (GRS: 38.8 ± 9 vs 34.3 ± 8; P = 0.04).ConclusionsSubclinical myocardial dysfunction can be detected by 2D and 3D-STE in type 1 diabetic patients, independently of any other cardiovascular risk factors. Diabetic cardiomyopathy progression was suggested by a mild decrease in longitudinal function at the follow-up, but did not extend to a clinical expression of the disease, as no death or over heart failure was reported.

Left ventricular functions in pediatric patients with ten years or more type 1 diabetes mellitus: Conventional echocardiography, tissue Doppler, and two‐dimensional speckle tracking study

“…Moreover, Bjornstad et al found a significantly lower GCS with unaffected GLS in adolescent T1DM patients with a median disease duration of 4.6 years . This finding is in contrast to other studies proved that the impairment in longitudinal strain is one of the earliest signs of myocardial dysfunction in type 1 DM in due to the subendocardial damage caused by coronary microvascular ischemia …”

“…Furthermore, Ringle et al showed that only longitudinal strain by 2D STE has significantly reduced in adults with T1DM than healthy controls after 6 years of follow up, whereas circumferential strain was preserved . They suggested that longitudinal fibers are affected early in diabetic cardiomyopathy, whereas the circumferential function affected only in long durations exceeding 10 years or coexisting complications.…”

“…Several studies have evaluated the LV myocardial changes in adult patients with T1DM using 2D speckle tracking echocardiography (2D STE) . However, limited studies in childhood utilized the 2D STE in the assessment of LV function in that disease .…”

Three‐dimensional speckle tracking echocardiography: Is it the magic wand in the diagnosis of subclinical myocardial dysfunction in children with type 1 diabetes mellitus?

“…Also, 3D‐LV AS was found to be lower in the prediabetic and diabetic patients than in the controls. Moreover, Ringle et al . and Ng et al .…”

“…showed that 2D longitudinal and radial functions of each LV segment were impaired in diabetic adult patients. Longitudinal strain impairment found to be one of the earliest sign of myocardial dysfunction in DM in several studies due to the effect of subendocardial damage caused by microvascular coronary ischemia …”