© 2014, Wiley Periodicals, Inc. DOI: 10.1111/echo.12790
Echocardiography
ORIGINAL INVESTIGATION
Left Ventricular Mechanics in Untreated Normotensive Patients with Type 2 Diabetes Mellitus: A Two- and Three-dimensional Speckle Tracking Study Marijana Tadic, M.D., Ph.D.,* Sanja Ilic, M.D.,† Cesare Cuspidi, M.D.,‡ Biljana Stojcevski, M.D.,* Branislava Ivanovic, M.D., Ph.D.,§** Ljiljana Bukarica, M.D., Ph.D.,¶ Ljilja Jozika, R.N.,* and Vera Celic, M.D., Ph.D.*** *Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje,” Belgrade, Serbia; †Department of Endocrinology, University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje”, Belgrade, Serbia; ‡Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy; §Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; ¶Department of Pharmacology, Faculty of Medicine, Belgrade, Serbia; and **Faculty of Medicine, Belgrade, Serbia
Background: Our aim was to investigate left ventricular (LV) mechanics estimated by two- (2DE) and three-dimensional echocardiography (3DE) strains in subjects with type 2 diabetes mellitus (DM). Methods: This cross-sectional study included 50 untreated normotensive DM subjects and 50 healthy controls similar by sex and age. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination. Results: Left ventricular mechanics, assessed by 2DE, was impaired in all three directions. Global longitudinal 3DE strain was significantly decreased in the DM group in comparison with the controls (17.8 2.5 vs. 19.1 2.7%, P = 0.014). Similar results were found for 3DE global circumferential strain (18.9 2.9 vs. 20.4 3.2%, P = 0.01), 3DE global radial strain (40.3 6.9 vs. 43.1 7.3%, P = 0.035), and 3DE global area strain (29.2 3.7 vs. 31 4%, P = 0.024). LV torsion was similar between the DM patients and the controls (2.1 0.6 vs. 1.9 0.5 °/cm, P = 0.073); whereas LV untwisting rate was significantly increased in the DM subjects (114 26 vs. -96 23 °/s, P < 0.001). A multivariate analysis showed that 3DE global longitudinal and area myocardial functions were associated with HbA1c independently of 3DE LV mass index. Conclusion: Left ventricular deformation obtained by 3DE is significantly impaired in the type 2 DM patients. HbA1c is independently associated with LV mechanics that implies that early anti-diabetic therapy and normalization of the fasting glucose level and HbA1c could impede further cardiac damage. (Echocardiography 2014;00:1–9) Key words: diabetes mellitus, left ventricle, three-dimensional echocardiography, speckle tracking imaging
Type 2 diabetes mellitus (DM), together with arterial hypertension, obesity, dyslipidemia and smoking, represents one of the most prevalent cardio- and cerebrovascular risk factors.1–3 At the same time, DM is one of the most important risk factors of cardiac remodeling.4,5 Left ventricular (LV) myocardial mechanics in DM has been investigated in several studies that demonstrated impaired LV deformation in these patients.6–12 However, there is no study that used threedimensional echocardiography (3DE) for the assessment of LV mechanics in untreated DM patients. Some authors used cardiac magnetic Address for correspondence and reprint requests: Marijana Tadic, M.D., Ph.D., University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje,” Heroja Milana Tepica 1, 11000 Belgrade, Serbia. Fax: +381112411464; E-mail: [email protected]
resonance imaging to obtain three-dimensional strain13,14 or compared well-controlled and uncontrolled DM patients using 3DE,7 but there is no investigation that compares the untreated normotensive DM subjects with the controls using 3DE. To our knowledge, LV torsion and untwist mechanics have not been studied in the untreated DM patients. We aimed to investigate LV mechanics using 2DE and 3DE speckle tracking imaging, as well as LV torsion and untwisting rate. Additionally, our objective was to determine a possible relationship between glycated hemoglobin and 3DE LV mechanics. Methodology: Our study included 50 normotensive patients (blood pressure
Echocardiography
ORIGINAL INVESTIGATION
Left Ventricular Mechanics in Untreated Normotensive Patients with Type 2 Diabetes Mellitus: A Two- and Three-dimensional Speckle Tracking Study Marijana Tadic, M.D., Ph.D.,* Sanja Ilic, M.D.,† Cesare Cuspidi, M.D.,‡ Biljana Stojcevski, M.D.,* Branislava Ivanovic, M.D., Ph.D.,§** Ljiljana Bukarica, M.D., Ph.D.,¶ Ljilja Jozika, R.N.,* and Vera Celic, M.D., Ph.D.*** *Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje,” Belgrade, Serbia; †Department of Endocrinology, University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje”, Belgrade, Serbia; ‡Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy; §Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; ¶Department of Pharmacology, Faculty of Medicine, Belgrade, Serbia; and **Faculty of Medicine, Belgrade, Serbia
Background: Our aim was to investigate left ventricular (LV) mechanics estimated by two- (2DE) and three-dimensional echocardiography (3DE) strains in subjects with type 2 diabetes mellitus (DM). Methods: This cross-sectional study included 50 untreated normotensive DM subjects and 50 healthy controls similar by sex and age. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination. Results: Left ventricular mechanics, assessed by 2DE, was impaired in all three directions. Global longitudinal 3DE strain was significantly decreased in the DM group in comparison with the controls (17.8 2.5 vs. 19.1 2.7%, P = 0.014). Similar results were found for 3DE global circumferential strain (18.9 2.9 vs. 20.4 3.2%, P = 0.01), 3DE global radial strain (40.3 6.9 vs. 43.1 7.3%, P = 0.035), and 3DE global area strain (29.2 3.7 vs. 31 4%, P = 0.024). LV torsion was similar between the DM patients and the controls (2.1 0.6 vs. 1.9 0.5 °/cm, P = 0.073); whereas LV untwisting rate was significantly increased in the DM subjects (114 26 vs. -96 23 °/s, P < 0.001). A multivariate analysis showed that 3DE global longitudinal and area myocardial functions were associated with HbA1c independently of 3DE LV mass index. Conclusion: Left ventricular deformation obtained by 3DE is significantly impaired in the type 2 DM patients. HbA1c is independently associated with LV mechanics that implies that early anti-diabetic therapy and normalization of the fasting glucose level and HbA1c could impede further cardiac damage. (Echocardiography 2014;00:1–9) Key words: diabetes mellitus, left ventricle, three-dimensional echocardiography, speckle tracking imaging
Type 2 diabetes mellitus (DM), together with arterial hypertension, obesity, dyslipidemia and smoking, represents one of the most prevalent cardio- and cerebrovascular risk factors.1–3 At the same time, DM is one of the most important risk factors of cardiac remodeling.4,5 Left ventricular (LV) myocardial mechanics in DM has been investigated in several studies that demonstrated impaired LV deformation in these patients.6–12 However, there is no study that used threedimensional echocardiography (3DE) for the assessment of LV mechanics in untreated DM patients. Some authors used cardiac magnetic Address for correspondence and reprint requests: Marijana Tadic, M.D., Ph.D., University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje,” Heroja Milana Tepica 1, 11000 Belgrade, Serbia. Fax: +381112411464; E-mail: [email protected]
resonance imaging to obtain three-dimensional strain13,14 or compared well-controlled and uncontrolled DM patients using 3DE,7 but there is no investigation that compares the untreated normotensive DM subjects with the controls using 3DE. To our knowledge, LV torsion and untwist mechanics have not been studied in the untreated DM patients. We aimed to investigate LV mechanics using 2DE and 3DE speckle tracking imaging, as well as LV torsion and untwisting rate. Additionally, our objective was to determine a possible relationship between glycated hemoglobin and 3DE LV mechanics. Methodology: Our study included 50 normotensive patients (blood pressure
