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. 2015 Apr 17:14:37.
doi: 10.1186/s12933-015-0201-8.

Clinical features of subclinical left ventricular systolic dysfunction in patients with diabetes mellitus

Yasuhide Mochizuki  1 , Hidekazu Tanaka  2 , Kensuke Matsumoto  3 , Hiroyuki Sano  4 , Hiromi Toki  5 , Hiroyuki Shimoura  6 , Junichi Ooka  7 , Takuma Sawa  8 , Yoshiki Motoji  9 , Keiko Ryo  10 , Yushi Hirota  11 , Wataru Ogawa  12 , Ken-ichi Hirata  13
Affiliations

Clinical features of subclinical left ventricular systolic dysfunction in patients with diabetes mellitus

Yasuhide Mochizuki et al. Cardiovasc Diabetol. .

Abstract

Background: Left ventricular (LV) longitudinal systolic dysfunction has been identified even in asymptomatic patients with diabetes mellitus (DM) and preserved LV ejection fraction (LVEF). However, its relevant clinical features have not been fully evaluated.

Methods: We studied 144 asymptomatic DM patients without coronary artery disease. Their mean age was 57 ± 15 years, 79 (55%) were female, and mean LVEF was 66 ± 4% (all ≥50%). Global longitudinal strain (GLS) was determined as the average peak strain of 18 segments from the three standard apical views, and was expressed as an absolute value. With the pre-defined cutoff for subclinical LV systolic dysfunction in DM patients with preserved LVEF set at GLS < 18%, this dysfunction was detected in 53 patients (37%).

Results: Multivariate logistic regression analysis revealed that type 2 DM, hypertriglyceridemia, overweight/obesity, nephropathy and neuropathy were independently associated with GLS < 18%, with nephropathy being the highest risk factor (OR: 5.26; 95% CI 2.111-13.12, p < 0.001). For sequential logistic regression models, a model based on clinical variables including gender, type 2 DM and DM duration (χ(2) = 24.1) was improved by addition of overweight/obesity and hypertriglyceridemia (χ(2) = 45.6, p < 0.001), and further improved by addition of nephropathy and neuropathy (χ(2) = 70.2, p < 0.001) as variables. Furthermore, albuminuria significantly correlated with GLS (r = -0.51, p < 0.001), and a multivariate regression model showed it to be the factor most closely associated with GLS (β = -0.33, p < 0.001).

Conclusions: Diabetic complications, hypertriglyceridemia and overweight/obesity were closely associated with early stage of LV systolic longitudinal myocardial dysfunction in asymptomatic DM patients with preserved LVEF. Our findings can be clinically noticeable for the management of DM patients.

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Figures

Figure 1
Figure 1
Example of color-coded 2-dimensional left ventricular (LV) display derived from the three standard apical views and corresponding peak longitudinal strain values derived from 18 LV segments for measurement of global longitudinal strain (GLS). GLS was determined as the average peak strain of the 18 LV segments, and was expressed as an absolute value.
Figure 2
Figure 2
The incremental advantage of using sequential logistic models for the prediction of GLS < 18%. A model based on clinical variables including gender, type 2 diabetes mellitus (DM) and DM duration (χ 2 = 24.1) was improved by the addition of hypertriglyceridemia and overweight /obesity (χ 2 = 45.6; p < 0.001), and further improved by the addition of nephropathy and neuropathy (χ 2 = 70.2; p < 0.001).
Figure 3
Figure 3
Dot plots of logarithmic albuminuria in relation to GLS show a significant negative correlation.
See this image and copyright information in PMC

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