Subclinical impairment of left ventricular function in diabetic patients with or without obesity

Abstract

Type 2 diabetic patients demonstrated early-stage subclinical LV deformation and dysfunction, whilst coexistent obesity resulted in further damage to myocardial contractility and reduced LVEF. 3DSTE was a sensitive method for detecting these abnormalities.

Subclinical Alterations of Cardiac Mechanics Present Early in the Course of Pediatric Type 1 Diabetes Mellitus: A Prospective Blinded Speckle Tracking Stress Echocardiography Study

“…Subdividing our T1DM population according to the degree of glycemic control, an association of both longitudinal and circumferential strains with serum levels of HbA 1c became evident (see Figure 3 ). This is in agreement with recent 3D speckle tracking studies demonstrating a negative impact of HbA 1c on LV myocardial strain in adult patients with diabetes mellitus [ 55 , 65 , 66 ]. Furthermore, this is underlined by prospective observational studies reporting the association of poor glycemic control with the development of heart failure in large cohorts of T1DM patients [ 5 , 67 ].…”

“…Strain rate however was not measured in that study. While there is a considerable number of clinical studies reporting an impairment of (mainly global longitudinal) strain in diabetes mellitus type 1 [ 51 – 53 ] and type 2 [ 54 ], all of these studies either include adult patients and/or are confounded by longer disease duration [ 51 , 55 – 57 ], LV structural abnormalities [ 51 , 55 , 58 ], impaired EF [ 52 ], obesity, arterial hypertension [ 51 , 54 , 59 – 61 ], nephropathy [ 51 , 57 , 61 ], heart failure [ 55 ], overt peripheral vascular disease [ 56 ], use of negatively inotropic medications [ 51 , 54 , 60 ], or tobacco use [ 51 ]. Furthermore, in contrast to our study design all of the abovementioned studies are considerably limited by the fact that the echocardiographic interpreter was not blinded.…”

Preclinical cardiovascular changes in children with obesity: A real-time 3-dimensional speckle tracking imaging study

“…First, the age of our study group was 11.5 ± 3.5 years, representing early cardiovascular changes associated with obesity. Obesity can lead to cardiac output increase and high LV wall tension, which may result in thickening of LV wall to compensate LV wall tension [ 28 ]. On the other hand, LV hypertrophy adapts to the enlargement of LV cavities and impairment of diastolic function while global systolic function is preserved.…”

Global Longitudinal Strain and Strain Rate in Type Two Diabetes Patients with Chronic Heart Failure: Relevance to Osteoprotegerin

“…Although global longitudinal strain is an excellent predictor of adverse LV remodeling and cardiac events in acute heart failure and decompensated CHF with preserved LVEF, T2DM patients with CHF are not considered optimal candidates for global longitudinal strain and strain rate measurements. 25 In fact, diabetic subjects even without overall obesity and lower LVEF may have signifi cantly declining global longitudinal strain and strain rate. Therefore, a reasonable correlation between LVEF and global longitudinal strain was found in CHF subjects with declined LVEF ≤40%.…”