Incremental prognostic value of global longitudinal strain in patients with type 2 diabetes mellitus

Abstract

BackgroundPatients with type 2 diabetes mellitus (T2DM) are at high risk for cardiovascular events. The aim of the study was to assess whether global longitudinal strain (GLS) provides prognostic value in these patients.MethodsA total of 247 T2DM patients without history of cardiovascular complications and participated in the CDATS study were prospectively enrolled. Left ventricular (LV) systolic function was assessed by LV ejection fraction and speckle tracking derived LV systolic GLS. Diastolic function was assessed by E/E′ ratio defined as the passive trans-mitral LV inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus. Cardiovascular event included acute coronary syndrome, cerebrovascular stroke, hospitalization for heart failure and cardiovascular death.ResultsA total of 18 cardiovascular events occurred during a median follow-up duration of 33 months. Both E/E′ ratio [hazard ratio (HR) 1.15, P < 0.01] and GLS (HR 1.39, P < 0.01) were independently associated with cardiovascular events. Importantly, GLS provided incremental prognostic information in addition to clinical data, HbA1c and E/E′ ratio (Chi square 77.46, P = 0.04). Receiver-operator characteristic curve analysis demonstrated that E/E′ ratio [area under curve (AUC) 0.66, P = 0.03] and GLS (AUC 0.72, P < 0.01) were strong predictors of cardiovascular events. Kaplan–Meier analysis showed that patients with E/E′ > 13.6 or GLS > −17.9 % were associated with cardiovascular events. The presence of either a high E/E′ ratio or an impaired GLS provides an excellent negative predictive value of cardiovascular events in these patients.ConclusionsIn T2DM patients with no history of cardiovascular disease, impaired GLS was associated with cardiovascular events and provided incremental prognostic value.

Periodontitis links to exacerbation of myocardial dysfunction in subjects with type 2 diabetes

“…Our previous study demonstrates that GLS > −17.9% provides reasonable prognostic value for cardiovascular events . In the present study, a greater percentage of subjects from CP group presented with GLS > −17.9% than that of the Control group (52% vs 20%, P < 0.05).…”

“…Currently, the cutoff incremental prognostic value for GLS remains variable. Our recent study shows that a reference cutoff level of GLS > −17.9% provides a reasonable sensitivity to predict CVD events in T2DM patients without macrovascular complications . In addition, GLS could be altered in spite of the preserved systolic function as determined by LVEF in conditions predisposing to CVD .…”

“…The primary outcome measure of the present study is GLS, and there are no prior studies on assessment of GLS in subjects with periodontitis. According to our recent study, a cohort of T2DM patients had a mean GLS value of −18.1 ± 2.4%, which was used as a reference to estimate sample size for the current study. As such, to detect an anticipated difference of 1.6% between the CP subjects and controls (2 to 1 ratio, based on our preliminary study), at least 90 subjects were required to achieve 90% power with one‐sided α = 0.05 .…”

“…Our recent study shows that a reference cutoff level of GLS > −17.9% provides a reasonable sensitivity to predict CVD events in T2DM patients without macrovascular complications. 24 In addition, GLS could be altered in spite of the preserved systolic function as determined by LVEF in conditions predisposing to CVD. 32 In the present study, the echocardiography with strain analysis may function as an effective and sensitive tool to detect subclinical systolic dysfunction and identify the subjects with diabetes and periodontitis who are at increased risk of developing CAD.…”

Characteristics of cardiomyopathy in Alström syndrome: Prospective single-center data on 38 patients

“…All right ventricular strain measurements were normal except in one child with limited image quality. Since GLS is known to be abnormal in hypertension [18], diabetes [19,20], dyslipidemia and obesity [21], we tested for correlations between GLS and cardiac risk factors (HTN, DM, hyperlipidemia) and other biomarkers (total cholesterol, HDL, LDL, triglycerides, CRP, and pro-BNP). In children, hemoglobin A 1c level ( r = 0.465, p = 0.025) and hs-CRP levels ( r = 0.512, p = 0.01) were moderately correlated with GLS.…”