Impact of acute hyperglycemia on layer-specific left ventricular strain in asymptomatic diabetic patients: an analysis based on two-dimensional speckle tracking echocardiography

Abstract

Background Hyperglycemia has detrimental effect on ischemic myocardium, but the impact of acute hyperglycemia on the myocardium in asymptomatic diabetic patients has not been fully elucidated. Thus, this follow-up study was aimed to investigate the effects and reversibility of acute hyperglycemia on regional contractile function of left ventricle (LV) in diabetic patients without cardiovascular disease. Methods The two-dimensional speckle tracking echocardiography (2D-STE), including multilayer strain analysis, was used for evaluation of global and regional LV function in asymptomatic, normotensive patients with uncomplicated diabetes, with acute hyperglycemia ( ≥ 11.1 mmol/l) (Group A, n = 67), or with optimal metabolic control (fasting plasma glucose < 7 mmol/l and HbA1c < 7%) (Group B, n = 20), while 20 healthy individuals served as controls (Group C). In group A, after 72 h of i.v. continuous insulin treatment (at the time euglycemia was achieved) (second examination) and after 3 months following acute hyperglycemia (third examination) 2D-STE was repeated. Results Global longitudinal strain (GLS) (− 19.6 ± 0.4%) in Group A was significantly lower in comparison to both groups B (− 21.3 ± 0.4%; p < 0.05) and C (− 21.9 ± 0.4%; p < 0.01) at baseline, while we could not detect the differences between groups B and C. Peak systolic longitudinal endocardial (Endo), mid-myocardial (Mid) and epicardial (Epi) layer strain were significantly lower in group A at baseline compared to both groups B and C. Deterioration in peak systolic circumferential strain was observed at basal LV level, in all three layers (Endo, Mid and Epi) and in mid-cavity LV level in Epi layer in group A in comparison to group C. Moreover, in group A, after euglycemia was achieved (at second and third examination) GLS, as well as peak longitudinal and circumferential strain remain the same. Conclusion Acute hyperglycemia in asymptomatic diabetic patients has significant negative effects on systolic LV myocardial mechanics primarily by reducing GLS and multilayer peak systolic longitudinal and circumferential strain which was not reversible after three months of good glycemic control.

The additive effects of type 2 diabetes mellitus on left ventricular deformation and myocardial perfusion in essential hypertension: a 3.0 T cardiac magnetic resonance study

“…In addition, studies in hypertension have found that GCPS was significantly reduced in patients with hypertrophy [17,23]. Recent studies showed the negative effects of acute hyperglycemia on systolic LV global longitudinal strain and multilayer longitudinal and circumferential strain in asymptomatic T2DM and unfavorable subclinical reductions in global and average circumferential strain in obese adolescents with dysglycemia, which may indicate the importance of intensive blood glucose control [24,25]. Moreover, epicardial adipose tissue may be associated with LV structural and functional abnormalities and exercise intolerance in T2DM patients with asymptomatic heart failure [26], and serum levels of omentin-1 and Zinc-α2-glycoprotein have been recently defined as the most important predictors for LV hypertrophy and LV diastolic dysfunction in T2DM patients [27].…”

Assessment of subclinical diabetic cardiomyopathy by speckle‐tracking imaging

“…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. Systolic dysfunction was correlated with lower absolute values of GLS, GCS or GRS, 4,7 GLS being independently associated with cardiovascular events, short‐ and long‐term hospital mortality, all‐cause death and hospitalization 1,5,14,17,18,21,31‐33 .…”

The additive effects of type 2 diabetes mellitus on left ventricular deformation and myocardial perfusion in essential hypertension: a 3.0T cardiac magnetic resonance study

“…In addition, studies in hypertension have found that GCPS was signi cantly reduced in patients with hypertrophy [17,23]. Recent studies showed the negative effects of acute hyperglycemia on systolic LV global longitudinal strain and multilayer longitudinal and circumferential strain in asymptomatic T2DM and unfavorable subclinical reductions in global and average circumferential strain in obese adolescents with dysglycemia, which may indicate the importance of intensive blood glucose control [24,25]. Moreover, epicardial adipose tissue may be associated with LV structural and functional abnormalities and exercise intolerance in T2DM patients with asymptomatic heart failure [26], and serum levels of omentin-1 and Zinc-α2-glycoprotein have been recently de ned as the most important predictors for LV hypertrophy and LV diastolic dysfunction in T2DM patients [27].…”