Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 21;17(2):e79429.
doi: 10.7759/cureus.79429. eCollection 2025 Feb.

A Correlation Between Left Ventricular Systolic Dysfunction, Identified on Global Longitudinal Strain, and Inducible Ischemia on 2D Stress Echocardiography in Type 2 Diabetes With Preserved Ejection Fraction

Vinay Kumar Sharma  1 , Rakesh Kumar Tikadar  2 , Sunil K Tripathi  2 , Mohit Tondon  1 , Puneet Aggarwal  3
Affiliations

A Correlation Between Left Ventricular Systolic Dysfunction, Identified on Global Longitudinal Strain, and Inducible Ischemia on 2D Stress Echocardiography in Type 2 Diabetes With Preserved Ejection Fraction

Vinay Kumar Sharma et al. Cureus. .

Abstract

Background: The relationship between glycemic control and cardiovascular outcomes is significant. Subclinical systolic impairment could be the first indicator of diabetic cardiomyopathy, even before detectable changes in ejection fraction.

Aim: To determine the prevalence of left ventricular (LV) systolic dysfunction by global longitudinal strain (GLS) in patients with asymptomatic type 2 diabetes mellitus (T2DM) patients with preserved ejection fraction and correlate GLS with stress echocardiography positivity rates in these patients. Methods: This prospective, observational, cross-sectional, single-center study included 150 asymptomatic T2DM patients with preserved left ventricular ejection fraction (LVEF≥50%). Patients underwent comprehensive echocardiography, which included GLS measurement and stress echocardiography. Patients were categorized based on GLS values (normal:≥-17%; reduced:<-17%) and stress echocardiography results.

Results: The LV systolic dysfunction, defined by reduced GLS, was observed in 37.7% of patients. Patients with reduced GLS were older (64.42±11.01 vs. 55.09±12.20 years, p<0.001), had higher HbA1c levels (8.6±0.99% vs. 7.05±1.05%, p<0.001), and longer diabetes duration (10.43±5.59 vs. 6.32±5.90 years, p<0.001). Stress echocardiography positivity was significantly higher in the reduced GLS group compared to the normal GLS group (17.9% vs 4.3%, p=0.006). Patients with positive stress echocardiography results showed significantly lower average GLS compared to those with negative results (16.16±3.96% vs 18.69±3.45%, p=0.04).

Conclusions: In asymptomatic T2DM patients with preserved LVEF, reduced GLS is associated with a higher rate of positive stress echocardiography results. The LV systolic dysfunction, indicated by reduced GLS, is common in diabetic patients and associated with higher HbA1c and longer diabetes duration.

Keywords: diabetes mellitus; echocardiography; global longitudinal strain; glycated haemoglobin; stress; ventricular dysfunction.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee of Fortis Escort Heart Institute issued approval IEC/2022/OAS/07. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

References

    1. Role of echocardiography in diabetic cardiomyopathy: from mechanisms to clinical practice. Urlic H, Kumric M, Vrdoljak J, et al. J Cardiovasc Dev Dis. 2023;10:46. - PMC - PubMed
    1. Echocardiography, an indispensable tool for the management of diabetics, with or without coronary artery disease, in clinical practice. Katogiannis K, Vlastos D, Kousathana F, et al. Medicina (Kaunas) 2020;56:709. - PMC - PubMed
    1. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Stratton IM, Adler AI, Neil HA, et al. BMJ. 2000;321:405–412. - PMC - PubMed
    1. Clinical features of subclinical left ventricular systolic dysfunction in patients with diabetes mellitus. Mochizuki Y, Tanaka H, Matsumoto K, et al. Cardiovasc Diabetol. 2015;14:37. - PMC - PubMed
    1. Evaluation of cardiac systolic function in asymptomatic diabetes patients and its correlation with duration of diabetes. Kumar A, Gupta S. https://www.worldwidejournals.com/paripex/recent_issues_pdf/2021/Novembe... Paripex. 2021;10:87–89.

LinkOut - more resources