European Journal of Echocardiography Advance Access originally published online on July 20, 2009
European Journal of Echocardiography 2009 10(8):926-932; doi:10.1093/ejechocard/jep097
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Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration
1 Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
2 Echocardiographic Laboratory, Tane General Hospital, Osaka, Japan
3 Non-invasive Imaging Laboratory, University of Chicago Medical Center, Chicago, IL, USA
Received 8 April 2009; accepted after revision 1 July 2009; online publish-ahead-of-print 20 July 2009.
* Corresponding author. Tel: +81 93 603 1611; fax: +81 93 691 6913. E-mail address: masaaki_takeuchi{at}hotmail.com
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Abstract |
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Aims: Early detection of diabetic heart disease is important for the timely interventions resulting in the prevention for the future development of heart failure. Subclinical left ventricular (LV) systolic dysfunction may be identified by a reduction in longitudinal function, which can be assessed using 2D speckle tracking echocardiography (STE).
Methods and results: To determine longitudinal, radial, and circumferential function, three LV short-axis and three LV apical views were acquired in 60 asymptomatic diabetic patients with normal LV ejection fraction (EF) and 25 age-matched healthy volunteers. Using 2D strain software, end-systolic longitudinal strain (LS), radial strain (RS), and circumferential strain (CS) were measured in 18 LV segments. No significant differences in LVEF were noted between two groups. Diabetic patients had more advanced diastolic dysfunction and increased LV mass compared with normal subjects. Basal, middle, and apical LSs were significantly lower in diabetic patients compared with control subjects, with 43% (26/60) of the diabetic patients showing abnormal global LS values (cut-off value: –17.2, mean – 2SD in control subjects). Basal RS and apical CS were also significantly lower in diabetic patients. Multivariate linear regression analysis showed that diabetic duration was the only independent confounder for the reduction of LS (t = 2.22, P = 0.0313).
Conclusion: In addition to diastolic dysfunction, subclinical LV longitudinal dysfunction is preferentially and frequently observed in asymptomatic diabetes patients with normal LVEF. The decrease in LS correlated with duration of diabetes. 2DSTE has the potential for detecting subclinical LV systolic dysfunction and might provide useful information of the risk stratification in an asymptomatic diabetic population.
Keywords: Speckle tracking; Longitudinal function; Strain; Diabetes mellitus