Improvement of Left Ventricular Global Longitudinal Strain after 6-Month Therapy with GLP-1RAs Semaglutide and Dulaglutide in Type 2 Diabetes Mellitus: A Pilot Study

Abstract

(1) Background: Glucagone-Like Peptide-1 Receptor Agonists (GLP-1 RAs) (GLP-1 RAs) are incretine-based medications recommended in the treatment of type 2 Diabetes Mellitus (DM2) with atherosclerotic cardiovascular disease (ASCVD) or high or very high cardiovascular (CV) risk. However, knowledge of the direct mechanism of GLP-1 RAs on cardiac function is modest and not yet fully elucidated. Left ventricular (LV) Global Longitudinal Strain (GLS) with Speckle Tracking Echocardiography (STE) represents an innovative technique for the evaluation of myocardial contractility. (2) Methods: an observational, perspective, monocentric study was conducted in a cohort of 22 consecutive patients with DM2 and ASCVD or high/very high CV risk, enrolled between December 2019 and March 2020 and treated with GLP-1 RAs dulaglutide or semaglutide. The echocardiographic parameters of diastolic and systolic function were recorded at baseline and after six months of treatment. (3) Results: the mean age of the sample was 65 ± 10 years with a prevalence of the male sex (64%). A significant improvement in the LV GLS (mean difference: −1.4 ± 1.1%; p value < 0.001) was observed after six months of treatment with GLP-1 RAs dulaglutide or semaglutide. No relevant changes were seen in the other echocardiographic parameters. (4) Conclusions: six months of treatment with GLP-1 RAs dulaglutide or semaglutide leads to an improvement in the LV GLS in subjects with DM2 with and high/very high risk for ASCVD or with ASCVD. Further studies on larger populations and with a longer follow-up are warranted to confirm these preliminary results.

Clinical study of two‐dimensional speckle tracking to evaluate abnormal myocardial motion due to coronary lesions

“…Many studies have shown that STE predicts subclinical damage to the left ventricle by detecting abnormalities in myocardial contractility, including hypertension, diabetes mellitus, and heart failure. [13][14][15] The purpose of this study is to identify potential risks in a timely manner when patients have OCAD. The positive correlation between GLS and mechanical dispersion and the degree of coronary stenosis confirms the importance of simultaneous evaluation of GLS and mechanical dispersion for the prediction of coronary artery disease.…”

“…The current limitation of speckle tracking to predict coronary artery disease is that the evaluation of myocardial motion is limited to myocardial contractility. Many studies have shown that STE predicts subclinical damage to the left ventricle by detecting abnormalities in myocardial contractility, including hypertension, diabetes mellitus, and heart failure 13–15 . The purpose of this study is to identify potential risks in a timely manner when patients have OCAD.…”

Epicardial and Pericoronary Adipose Tissue, Coronary Inflammation, and Acute Coronary Syndromes

“…EAT, which is in close proximity to myocardiocytes, can release proinflammatory and pro-atherogenic substances directly into the coronary lumen under pathological conditions. The transcriptome of EAT encodes inflammatory cytokines, affecting its pro-atherogenic characteristics, especially in unfavorable metabolic conditions like diabetes [49][50][51][52][53][54]. Radiographic fat density correlates with adipocyte enlargement, while CT attenuation is inversely related to adipocyte size.…”

Assessment and management of Heart Failure in Patients with Chronic Kidney Disease

“…Furthermore, the repetition of the echocardiogram is useful even when a change in the clinical picture suggests a change in ventricular function. Additional techniques such as Tissue Doppler Imaging (TDI) and Strain Rate (SR) should be incorporated into the protocol to identify patients who are at risk of HF or to identify early worsening of HF [50,51]. Hassanin N et al, showed that in patients with CKD, LV longitudinal systolic strain and early and late diastolic strain rates are significantly reduced despite preserved FE, identifying early patients at high risk of developing HF [52].…”