Left ventricular anatomical and functional changes with ageing in type 2 diabetic adults

Stefanidis, Alexander; Bousboulas, Stavros; Kalafatis, John; Baroutsi, Kyriaki; Margos, Panagiotis; Komninos, Komninos; Pappas, Stavros; Papasteriadis, E.

doi:10.1093/ejechocard/jep026

Cited by 15 publications

(18 citation statements)

References 22 publications

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“…Such alterations lead to cardiomyocyte necrosis and apoptosis associated with fibrosis and subsequent myocardial dysfunction, which is called diabetic cardiomyopathy (33). At an early stage, US techniques for myocardial strain assessment such as tissue Doppler imaging (22,(34)(35)(36)(37)(38) and speckle tracking imaging (23)(24)(25) help show decreases in systolic function in DM patients without patent cardiomyopathy, compared with that in normoglycemic patients. Because of technical issues, longitudinal dysfunction (22,(34)(35)(36)(37)(38) has been well validated by using US techniques.…”

Section: Discussionmentioning

confidence: 99%

“…At an early stage, US techniques for myocardial strain assessment such as tissue Doppler imaging (22,(34)(35)(36)(37)(38) and speckle tracking imaging (23)(24)(25) help show decreases in systolic function in DM patients without patent cardiomyopathy, compared with that in normoglycemic patients. Because of technical issues, longitudinal dysfunction (22,(34)(35)(36)(37)(38) has been well validated by using US techniques. In comparison, the importance of radial dysfunction is more controversial (24,25,34,35), but circumferential function is largely unexplored, with only preliminary and conflicting data (23,24).…”

Section: Discussionmentioning

confidence: 99%

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Systolic Myocardial Dysfunction in Patients with Type 2 Diabetes Mellitus: Identification at MR Imaging with Cine Displacement Encoding with Stimulated Echoes

Ernande¹,

Thibault²,

Bergerot³

et al. 2012

Radiology

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Purpose:To determine if cine displacement encoding with stimulated echoes (DENSE) can help to identify and determine the patterns of subclinical myocardial systolic dysfunction in patients with type 2 diabetes mellitus (DM) when compared with cine DENSE in control patients. Materials and Methods:After obtaining approval from the institutional ethics committee and written informed consent from the patients, 37 patients with type 2 DM without overt heart disease and 23 age-matched control patients were prospectively included in the study. The patients underwent standard cine magnetic resonance (MR) imaging with two-dimensional cine DENSE acquisitions. Circumferential (Ecc) and radial (Err) systolic strains were measured on short-axis views at basal, mid, and apical left ventricular levels. Longitudinal strain (Ell) was measured on four-and two-chamber views. Statistical testing included the intraclass correlation coefficient and multiple linear regression analysis. Results:The intraobserver intraclass correlation coefficient values were 0.85, 0.95, and 0.90, and the interobserver intraclass correlation coefficient values were 0.79, 0.91 and 0.80 for Ecc, Err, and Ell, respectively. The left ventricular ejection fraction was in the reference range and similar between the groups, and the patients with DM showed a decrease in Ecc (214.4% 6 1.6 vs 217.0% 6 1.6, P , .001), Err (36.2% 6 10.9 vs 44.4% 6 9.9, P = .006) and Ell (212.9% 6 2.1 vs 215.5% 6 1.6, P , .001) compared with the control patients. Finally, DM was independently associated with Ecc (P , .001), Err (P = .05) and Ell (P = .01) after adjustment for age, sex, hypertension, body mass index, and left ventricular mass. Conclusion:Cine DENSE, a motion-encoding MR imaging technique for myocardial strain assessment with high spatial resolution, appears to be useful in the identification of subclinical myocardial dysfunction in patients with DM.q RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup /suppl

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systolic Myocardial Dysfunction in Patients with Type 2 Diabetes Mellitus: Identification at MR Imaging with Cine Displacement Encoding with Stimulated Echoes

Ernande¹,

Thibault²,

Bergerot³

et al. 2012

Radiology

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“…With the advent of recent echocardiographic techniques, there is emerging evidence of subtle abnormalities in long-axis systolic function in these patients. [4][5][6][7] Our results showed that patients with diabetic microvascular complications had a decreased longitudinal average isovolumic contraction acceleration not only at the mitral annulus but also at the 3 levels of the LV wall, which showed the presence of global and regional systolic dysfunction in the long-axis direction. In addition, patients without diabetic microvascular complications had regional longitudinal systolic dysfunction, although the global LV longitudinal contractility was normal.…”

Section: Left Ventricular Systolic Dysfunctionmentioning

confidence: 56%

“…[4][5][6][7] However, only a few studies have been performed regarding radial systolic function, and data about the changes in radial systolic function in diabetic patients are still controversial. [7][8][9] Conventional echocardiography is not sensitive enough to detect subtle changes in radial contractility.…”

mentioning

confidence: 99%

“…[7][8][9] Conventional echocardiography is not sensitive enough to detect subtle changes in radial contractility. Although tissue Doppler imaging is more capable of detecting subtle regional abnormalities in LV function, it only allows assessment of myocardial longitudinal function [3][4][5][6] or radial function in the LV anteroseptum and inferolateral wall 8 because of its angle dependency. Recently developed velocity vector imaging overcomes this limitation, which can automatically track the endocardial border to determine the myocardial velocity, strain rate, and strain without angle dependency.…”

mentioning

confidence: 99%

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Left Ventricular Radial Systolic Dysfunction in Diabetic Patients Assessed by Myocardial Acceleration Derived From Velocity Vector Imaging

Zhang

et al. 2012

Journal of Ultrasound in Medicine

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Objectives The purpose of this study was to determine whether left ventricular (LV) radial systolic dysfunction occurred in diabetic patients with a normal left ventricular ejection fraction (LVEF) and impaired longitudinal contraction. Methods Velocity vector imaging was performed in 22 patients with type 2 diabetes without microangiopathy (12 men and 10 women; mean age ± SD, 49 ± 7 years), 21 patients with microangiopathy (12 men and 9 women; mean age, 50 ± 6 years), and 21 healthy control participants (11 men and 10 women; mean age, 49 ± 8 years). The groups were matched for age and sex. All had no clinical symptoms of heart disease, coronary artery disease, or hypertension. Results The LVEF, fractional shortening, and end‐diastolic diameter were statistically comparable in all groups. The left ventricular wall thickness was significantly greater in diabetic patients than controls (P < .05). Average peak early diastolic accelerations at all LV levels were significantly lower in diabetic patients than controls in the long‐and short‐axis directions (all P < .05). In the long‐axis direction, a significantly lower average peak isovolumic contraction acceleration was found at the mid and apical levels in patients without microangiopathy and at all LV levels in patients with microangiopathy than controls (all P < .05). In the short‐axis direction, a significantly lower average isovolumic contraction acceleration was found at the apical level in patients without microangiopathy and at the basal and apical levels in patients with microangiopathy (all P < .05). Conclusions In diabetic patients with a normal LVEF, myocardial systolic dysfunction occurs not only in the long‐axis direction but also in the short‐axis direction.

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The diabetic cardiomyopathy

et al. 2010

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Diabetic cardiomyopathy has been defined as "a distinct entity characterized by the presence of abnormal myocardial performance or structure in the absence of epicardial coronary artery disease, hypertension, and significant valvular disease". The diagnosis stems from the detection of myocardial abnormalities and the exclusion of other contributory causes of cardiomyopathy. It rests on non-invasive imaging techniques which can demonstrate myocardial dysfunction across the spectra of clinical presentation. The presence of diabetes is associated with an increased risk of developing heart failure, and the 75% of patients with unexplained idiopathic dilated cardiomyopathy were found to be diabetic. Diabetic patients with microvascular complications show the strongest association between diabetes and cardiomyopathy, an association that parallels the duration and severity of hyperglycemia. Metabolic abnormalities (that is hyperglycemia, hyperinsulinemia, and hyperlipemia) can lead to the cellular alterations characterizing diabetic cardiomyopathy (that is myocardial fibrosis and/or myocardial hypertrophy) directly or indirectly (that is by means of renin-angiotensin system activation, cardiac autonomic neuropathy, alterations in calcium homeostasis). Moreover, metabolic abnormalities represent, on a clinical ground, the main therapeutic target in the patients with diabetes since the diagnosis of diabetes is made. Since diabetic cardiomyopathy is highly prevalent in the asymptomatic type 2 diabetic patients, screening for its presence at the earliest stage of development can lead to prevent the progression to chronic heart failure. The most sensitive test is standard echocardiogram, while a less expensive pre-screening method is the detection of microalbuminuria.

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Left ventricular anatomical and functional changes with ageing in type 2 diabetic adults

Abstract: Type 2 diabetic patients demonstrate an early and concomitant induction of systolic and diastolic myocardial dysfunction as a preclinical manifestation of diabetic cardiomyopathy.

Cited by 15 publications

References 22 publications

Systolic Myocardial Dysfunction in Patients with Type 2 Diabetes Mellitus: Identification at MR Imaging with Cine Displacement Encoding with Stimulated Echoes

Systolic Myocardial Dysfunction in Patients with Type 2 Diabetes Mellitus: Identification at MR Imaging with Cine Displacement Encoding with Stimulated Echoes

Left Ventricular Radial Systolic Dysfunction in Diabetic Patients Assessed by Myocardial Acceleration Derived From Velocity Vector Imaging

The diabetic cardiomyopathy

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