Subclinical right ventricular dysfunction in diabetes mellitus—an ultrasonic strain/strain rate study

Kosmala, Wojciech; Przewlocka‐Kosmala, M.; Mazurek, Walentyna

doi:10.1111/j.1464-5491.2007.02101.x

Cited by 53 publications

(40 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 97%

“…Diabetes is associated with profound changes in cardiac metabolism, structure and function, and with an increased risk of development of heart failure, even in the absence of frequently coexisting co-morbidities such as coronary artery diseases and hypertension [16][17][18]. In particular, in asymptomatic diabetic patients without coronary artery diseases and hypertension, an early impairment of right ventricular diastolic function is observed [17][18][19]. This subclinical dysfunction could be due to myocardial fibrosis secondary to the accumulation of advanced glycation endproducts in the myocardium itself; furthermore, a direct correlation between diastolic dysfunction and HbA1c levels in diabetic patients has been reported [20][21][22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…Both type 2 diabetes mellitus and chronic obstructive pulmonary disease are characterized by impairment of right ventricular function, diagnosed by trans-thoracic echocardiography also in the absence of acute PE [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Diabetes is associated with profound changes in cardiac metabolism, structure and function, and with an increased risk of development of heart failure, even in the absence of frequently coexisting co-morbidities such as coronary artery diseases and hypertension [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with central and non-massive pulmonary embolism

Rendina

Bonis²,

Gallotta

et al. 2009

Intern Emerg Med

View full text Add to dashboard Cite

Right ventricular dysfunction during acute pulmonary embolism (PE) predisposes to hemodynamic instability and cardiogenic shock. Aim of this case-control study was to determine the clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with acute PE involving the main or segmental pulmonary arteries (central PE) and without hemodynamic instability on admission to the Emergency Department (ED) (non-massive PE). From January 1, 2002 to December 31, 2005, 211 patients with central PE were admitted to the Department of Emergency Medicine of the "Antonio Cardarelli" Hospital (Naples, Italy). One hundred eighteen of them had echocardiographic evidence of right ventricular dysfunction on admission to the ED. A history of type 2 diabetes mellitus and chronic obstructive pulmonary disease were significantly associated with an increased risk of this PE-related complication. Compared to patients without right ventricular dysfunction, those with right ventricular dysfunction showed higher levels of markers of cardiac damage, and a significant impairment of respiratory function. Echocardiographic evidence of right ventricular dysfunction on admission to the ED was significantly associated with the occurrence of hemodynamic instability and cardiogenic shock during the PE clinical course. The study results indicate that a history of type 2 diabetes mellitus and chronic obstructive pulmonary disease are significantly associated with the occurrence of right ventricular dysfunction in patients with non-massive and central PE independent of age, gender and other historical and clinical variables detectable on admission to the ED.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with central and non-massive pulmonary embolism

Rendina

Bonis²,

Gallotta

et al. 2009

Intern Emerg Med

View full text Add to dashboard Cite

show abstract

“…The assessment of atrial function is clinically important because atria are not only reservoirs, but also active contractile chambers that have the ability of ventricular filling during ventricular diastole. This is particularly important in the diastolic dysfunction of both ventricles, which is frequent among diabetics [11,12].…”

Section: Introductionmentioning

confidence: 99%

Left and right atrial phasic function and deformation in untreated patients with prediabetes and type 2 diabetes mellitus

Tadić

Ilić

Cuspidi

et al. 2014

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

To evaluate phasic function and deformation of the left atrium (LA) and right atrium (RA) in subjects with prediabetes and type 2 diabetes mellitus. This cross-sectional study included 50 untreated normotensive subjects with prediabetes, 60 recently diagnosed normotensive diabetic patients and 60 healthy controls of similar sex and age. All the subjects underwent laboratory analyses and complete echocardiographic examination including strain analysis. LA and RA reservoir and conduit function gradually decreased, while booster pump increased, from the healthy controls, throughout the prediabetics, to the diabetics. The strain analysis of atrial phasic function showed more regular pattern of progressive atrial function deterioration than conventional evaluation with total, active and passive atrial function. In the whole study population HbA1c correlated with LA passive emptying fraction (r = -0.38, p < 0.01), LA active emptying fraction (r = 0.36, p < 0.01), LA longitudinal strain during systole (r = -0.35, p < 0.01), RA passive emptying fraction (r = -0.42, p < 0.01), RA active emptying fraction (r = 0.38, p < 0.01), and RA longitudinal strain during systole (r = -0.32, p < 0.01). However, only LA passive emptying fraction (β = -0.32, p < 0.01) and LA longitudinal strain during systole (β = -0.28, p = 0.02) were independently associated with HbA1c among the LA parameters; whereas solely RA passive emptying fraction (β = -0.37, p < 0.01) and RA active emptying fraction (β = 0.31, p = 0.01) were independently associated with HbA1c among the RA parameters. LA and RA phasic functions are significantly impaired in the prediabetics and the diabetics. The parameter of glucose control correlated with LA and RA reservoir, conduit and pump atrial function.

show abstract

“…Abdelaziz 16 showed right ventricular myocardial performance index (MPI ) was significantly higher in diabetic group .Kosmala et al . 18 demonstrated subclinical RV dysfunction by the strain/ strain rate technique in diabetics.Wang et al . 19 determined which echocardiographic variables best correlated with RV ejection fraction as assessed by cardiac magnetic resonance imaging and found that right ventricular fractional area (RVFAC) change , MPI , isovolumic acceleration were the best correlated variables…”

Section: Discussionmentioning

confidence: 99%

Early Detection of Right Ventricular Dysfunction by Myocardial Performance Index in Diabetic Patients

et al. 2015

View full text Add to dashboard Cite

Introduction :Diabetes mellitus is one of the most common endocrine disorders. The incidence of diabetes mellitus is continuously increasing and about 90% of patients of diabetes mellitus have type 2 diabetes mellitus . 1 Reports from the Framingham study and other studies have established diabetes as a strong risk factor for cardiovascular morbidity and mortality. [2][3][4] Diabetes mellitus has direct effects on the heart, independent of obstructive disease and hypertension and causes development of a specific cardiomyopathy. 5 Several studies using echocardiography have demonstrated deterioration in left ventricular diastolic properties in diabetic patients. [6][7][8][9] RV function has proven to be of importance for risk stratification in heart failure and is associated with sudden death and exercise limitation . 10 RV function has not been studied in depth yet in diabetic patients although the RV has an important contribution to the overall cardiac function . 11 RV dysfunction especially diastolic dysfunction may play a role in diabetic cardiomyopathy. 10 The majority of proposed methods of echocardiographic assessment of RV function are based on volumetric approximations of RV .Such approaches have inherent limitations ,first as volume related measures such as ejection fraction (EF) are load dependant; second because of the complex geometry of RV . 12 The issue of RV geometry is usually overcome using geometry -independent parameters such as tricuspid annular velocity and MPI .MPI is calculated using Doppler as the ratio of the isovolumic contraction and relaxation times to the ejection time which encompasses both systolic and diastolic functions. 13 In systolic dysfunction ,the isovolumic contraction time increases ,whereas the ejection time decreases and ,consequently , the MPI increases. In diastolic dysfunction, there is prolongation of isovolumic relaxation time that also results in an increased MPI .Tei et al. 14 proposed a Tei index (or myocardial performance index ) ,obtained from Doppler time intervals, which allows simple noninvasive and nongeometric estimation of global ventricular functions. It has been found to have prognostic value for various cardiac conditions .Yeo et al. 15 reported Doppler right ventricular index to be a useful noninvasive parameter that correlates with symptoms and survival in patients with pulmonary hypertension .Data regarding RV performance in patients with diabetes are incomplete. Some studies have been shown right ventricular dysfunction. Myocardial dysfunction in patients with diabetes mellitus is not confined to the left ventricle, but also involves the right ventricle, and the impairment of RV function encompasses both systolic and diastolic abnormalities. Abstract:In diabetes mellitus (DM) patients, left ventricular dysfunction is widely evaluated and established by conventional diagnostic methods, whereas right ventricular (RV) function is not sufficiently evaluated. The aim of this study was to assess the right ventricular function in type 2 diabetic patients...

show abstract

Subclinical right ventricular dysfunction in diabetes mellitus—an ultrasonic strain/strain rate study

Abstract: Diabetes mellitus is associated with subclinical RV systolic and diastolic dysfunction, regardless of coexisting hypertension.

Cited by 53 publications

References 31 publications

Clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with central and non-massive pulmonary embolism

Clinical, historical and diagnostic findings associated with right ventricular dysfunction in patients with central and non-massive pulmonary embolism

Left and right atrial phasic function and deformation in untreated patients with prediabetes and type 2 diabetes mellitus

Early Detection of Right Ventricular Dysfunction by Myocardial Performance Index in Diabetic Patients

Contact Info

Product

Resources

About