Three-dimensional assessment of left ventricular systolic strain in patients with type 2 diabetes mellitus, diastolic dysfunction, and normal ejection fraction

2004 ◽  
Vol 94 (11) ◽  
pp. 1391-1395 ◽  
Author(s):  
Carissa G. Fonseca ◽  
Ajith M. Dissanayake ◽  
Robert N. Doughty ◽  
Gillian A. Whalley ◽  
Greg D. Gamble ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Ejection Fraction ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Normal Ejection Fraction ◽  
Systolic Strain ◽  
Dimensional Assessment

scholarly journals The chronic heart failure early stage predictors in type 2 diabetes mellitus

2021 ◽  
pp. 4-16
Author(s):  
D.V. Grazhdankina ◽  
◽  
A.A. Demin ◽  
I.A. Bondar ◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Duration Of Diabetes ◽  
Initial Symptoms

Introduction. Type 2 diabetes mellitus (T2DM) is considered to be the equivalent of cardiovascular disease due to its micro- and macrovascular complications. Insulin resistance and hyperinsulinemia, impaired glucose tolerance and fasting glucose, and their subsequent maladaptive responses lead to myocardial dysfunction several years before the onset of T2DM. Pathological changes in the cardiovascular system in T2DM can progress without any symptoms for a long time. Aim. To identify clinical, laboratory, echocardiographic predictors of the early manifestations of chronic heart failure (CHF) in patients with T2DM. Materials and methods. The study included 94 patients with T2DM with and without initial symptoms of CHF at the age of 40 to 65 years. All patients had obesity or excess body weight and arterial hypertension (AH), 37 patients had stable coronary heart disease (CHD). Patients underwent general clinical and laboratory examination, a 6-minute walk test (6MWT), echocardiography. The concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP ) was also determined. The patients were divided into 2 groups: without CHF symptoms (group 1, n = 54) and with initial symptoms of CHF (group 2, n = 40) and then these groups were compared. Results. Differences were revealed between the second and first groups in the duration of T2DM (10.5 vs 7.5 years, p = 0.02) and AH (15 vs 10 years, p = 0.009); the incidence of stable CHD (70 vs 16.7%, p < 0.0001); distance covered during 6MWT (375 vs 425 m, p < 0.0001); the median level of NT-proBNP (38.5 vs 27.2 pg/ml, p = 0.031); the left atrium (LA) size (4.4 vs 4.2 cm, p = 0.044); the left ventricular posterior wall thickness (PWT) (1.05 vs 0.95 cm, p = 0.02); the level of triglycerides (2.3 vs 1.6 mmol/l, p = 0.03) and the glomerular filtration rate (GFR) (74.1 vs 79.1 ml/min/1.73 m2, r = 0.04). The discriminant analysis revealed combination of factors associated with initial symptoms of CHF: the duration of CHD (taken as 0, if absent, p < 0.00001), PWT of the LV (p = 0.000007), GFR (p = 0.0009), the LA size (p = 0.005), the level of triglycerides (p = 0.03), the duration of T2DM (p = 0.046). The NT-proBNP level > 125 pg/ml was detected in 16% of patients with T2DM and correlated with the duration of diabetes over 10 years (p = 0.0085), the presence of stable CHD (p < 0.0001), and left ventricular mass index (p = 0.0005) and the ejection fraction of the LV (p < 0.0001). Conclusion. Predictors of the initial manifestations of chronic heart failure in patients with type 2 diabetes mellitus were the presence and duration of stable CHD, an increase in the PWT of the LV, the LA size, the level of triglycerides, and the duration of diabetes. An elevated level of NT-proBNP (more than 125 pg/ml) in patients with T2DM was detected in 16% of cases and was associated with the duration of diabetes for more than 10 years, presence of stable CHD, initial symptoms of CHF, left ventricular myocardial hypertrophy, and a lower left ventricular ejection fraction according to echocardiography.

scholarly journals Association of glycemic variability with left ventricular diastolic function in type 2 diabetes mellitus

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Shun Yokota ◽  
Hidekazu Tanaka ◽  
Yasuhide Mochizuki ◽  
Fumitaka Soga ◽  
Kentaro Yamashita ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Glycemic Variability ◽  
Left Ventricular ◽  
Lv Diastolic Dysfunction ◽  
Lv Diastolic Function

Abstract Background Type 2 diabetes mellitus (T2DM) is a major cause of heart failure (HF) with preserved ejection fraction (HFpEF), usually presenting as left ventricular (LV) diastolic dysfunction. Thus, LV diastolic function should be considered a crucial marker of a preclinical form of DM-related cardiac dysfunction. However, the impact of glycemic variability (GV) on LV diastolic function in such patients remains unclear. Methods We studied 100 asymptomatic T2DM patients with preserved LV ejection fraction (LVEF) without coronary artery disease (age: 60 ± 14 years, female: 45%). GV was evaluated as standard deviation of blood glucose level using continuous glucose monitoring system for at least 72 consecutive hours. LV diastolic function was defined as mitral inflow E and mitral e’ annular velocities (E/e’), and > 14 was determined as abnormal. Results E/e’ in patients with high GV (≥ 35.9 mg/dL) was significantly higher than that in patients with low GV (11.3 ± 3.9 vs. 9.8 ± 2.8, p = 0.03) despite similar age, gender-distribution, and hemoglobin A1c (HbA1c). Multivariate logistic regression analysis showed that GV ≥ 35.9 mg/dL (odds ratio: 3.67; 95% confidence interval: 1.02–13.22; p < 0.05) was an independently associated factor, as was age, of E/e’ > 14. In sequential logistic models for the associations of LV diastolic dysfunction, one model based on clinical variables including age, gender and hypertension was not improved by addition of HbA1c (p = 0.67) but was improved by addition of high GV (p = 0.04). Conclusion Since HFpEF is a syndrome caused by diverse agents, reducing GV may represent a potential new therapeutic strategy for the prevention of the development of HFpEF in T2DM patients.

scholarly journals Influence of beta-blockers on mechanical dyssynchrony and cardiac remodeling in patients with ischemic chronic heart failure in the setting of revascularization

2019 ◽  
Vol 5 (1) ◽  
pp. 1-13
Author(s):  
Irina V. Askari ◽  
Olga A. Osipova
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Average Dose

Introduction: Diastolic dysfunction (DD) and cardiac dyssynchrony (DS) are involved in the progression of chronic heart failure (CHF). A comparative analysis was conducted of the effect of a 6-month course of nebivolol and bisoprolol on DD, DS and metalloproteinase-9 (MMP-9) level in patients with ischemic chronic heart failure with preserved ejection fraction (HFpEF) and with midrange ejection fraction (HFmrEF), as well as in patients with comorbid type 2 diabetes mellitus (T2DM) in the setting of coronary artery bypass grafting (CABG) after 6 months of therapy. Materials and methods: The study included 308 patients with CHFFC I-II, left ventricular ejection fraction (LVEF) &gt;40%, who had undergone CABG. The average dose of nebivolol in patients with DS 6 months later was 5.1±2.6 mg/day, and bisoprolol – 4.9±2.4 mg/day. Echocardiography (EchoCG) and evaluation of MMP-9 in blood plasma were performed. Mechanical myocardial asynchrony was determined by calculating the standard deviation of time to peak systolic myocardial velocity (TS-SD) and maximum segment delay (TS12) using a 6-basal and-midsegment model. Results and discussion: MMP-9 level in patients with CHF before CABG was 4.7 times higher (p&lt;0.001). MMP-9 correlated with LVEF (r=-0.60, p&lt;0.001), E/A (r=-0.49, p&lt;0.001), DT (r=0.43, p&lt;0.001), E` (r=-0.58, p&lt;0.001) and DS: TS12 (r=0.54, p&lt;0.001), TS-SD (r=0.49, p&lt;0.001). The six-month course of nebivolol improved the values of DS: TS12 – by 30% (p&lt;0.001), TS-SD – by 32% (p&lt;0.01) and reduced the MMP-9 level by 11% (p&lt;0.001). In patients with HFmrEF without DSnebivolol increased E/A by 19% (p&lt;0.01), E` – by 16% (P&lt;0.05), and decreased E/E’ by 9% (p&lt;0.05), DT – by 12% (p&lt;0.05). In patients with HFpEF and DM2, nebivolol reduced TS12 by 37% (p&lt;0.01), TS-SD – by 29% (p&lt;0.05) and MMP-9 – by 13% (p&lt;0.05). Conclusion: The positive effect of nebivolol on the DS, DD of the LV in patients with HFpEF, HFmrEF and with comorbid type 2 diabetes mellitus. The six-month course of nebivolol decreased the MMP-9 level in patients with ischemic CHF after CABG, including patients with T2DM.

scholarly journals Effect of heart rate on left ventricular longitudinal myocardial function in type 2 diabetes mellitus

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yuki Yamauchi ◽  
Hidekazu Tanaka ◽  
Shun Yokota ◽  
Yasuhide Mochizuki ◽  
Yuko Yoshigai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Heart Rate ◽  
Type 2 Diabetes Mellitus ◽  
Myocardial Function ◽  
Normal Subjects ◽  
Left Ventricular ◽  
High Heart Rate ◽  
Lv Dysfunction

Abstract Background Left ventricular (LV) longitudinal myocardial dysfunction is considered a marker of preclinical LV dysfunction in patients with type 2 diabetes mellitus (T2DM). High heart rate (HR) is associated with cardiovascular outcomes, but the effect of HR on LV longitudinal myocardial function in T2DM patients is uncertain. Methods We studied 192 T2DM patients with preserved LV ejection fraction (LVEF), and 81 age-, sex-, and LVEF-matched healthy volunteers. HR was measured as the average HR during echocardiography, and high HR was defined as resting HR ≥ 70 beats/minute. LV longitudinal myocardial function was assessed as global longitudinal strain (GLS). The predefined cutoff for subclinical LV dysfunction was set at GLS < 18%. Results GLS in T2DM patients with high HR was significantly lower than that in T2DM patients with low HR (16.3% ± 4.2% vs. 17.8% ± 2.8%; P = 0.03), whereas GLS in normal subjects with high and low HR was similar (20.3 ± 1.7% vs. 20.3 ± 2.0%; P = 0.99). Multivariable logistic regression analysis showed that high HR (odds ratio: 1.04; 95% confidence interval: 1.01–1.07; P = 0.01) was independently associated with GLS < 18% in T2DM patients as well as HbA1c, T2DM duration, LVEF, body mass index, and mitral inflow E and mitral e’ annular velocity ratio. One sequential logistic model evaluating the associations between GLS < 18% and clinical variables in T2DM patients showed an improvement with the addition of LVEF and E/e’ (P < 0.001) and a further improvement with the addition of high HR (P < 0.001). Conclusion Compared with normal subjects, resting HR was associated with LV longitudinal myocardial function in asymptomatic T2DM patients with preserved LVEF. Our findings provide new insights on the management of T2DM patients.

scholarly journals Aggravation of functional mitral regurgitation on left ventricle stiffness in type 2 diabetes mellitus patients evaluated by CMR tissue tracking

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yi Zhang ◽  
Wei-feng Yan ◽  
Li Jiang ◽  
Meng-ting Shen ◽  
Yuan Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mitral Regurgitation ◽  
Strain Rate ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Lv Function ◽  
Peak Strain

Abstract Background Functional mitral regurgitation (FMR) is one of the most common heart valve diseases in diabetes and may increase left ventricular (LV) preload and aggravate myocardial stiffness. This study aimed to investigate the aggravation of FMR on the deterioration of LV strain in type 2 diabetes mellitus (T2DM) patients and explore the independent indicators of LV peak strain (PS). Materials and methods In total, 157 T2DM patients (59 patients with and 98 without FMR) and 52 age- and sex-matched healthy control volunteers were included and underwent cardiac magnetic resonance examination. T2DM with FMR patients were divided into T2DM patients with mild (n = 21), moderate (n = 19) and severe (n = 19) regurgitation. LV function and global strain parameters were compared among groups. Multivariate analysis was used to identify the independent indicators of LV PS. Results The T2DM with FMR had lower LV strain parameters in radial, circumferential and longitudinal direction than both the normal and the T2DM without FMR (all P < 0.05). The mild had mainly decreased peak diastolic strain rate (PDSR) compared to the normal. The moderate had decreased peak systolic strain rate (PSSR) compared to the normal and PDSR compared to the mild and the normal. The severe FMR group had decreased PDSR and PSSR compared to the mild and the normal (all P < 0.05). Multiple linear regression showed that the regurgitation degree was independent associated with radial (β = − 0.272), circumferential (β = − 0.412) and longitudinal (β = − 0.347) PS; the months with diabetes was independently associated with radial (β = − 0.299) and longitudinal (β = − 0.347) PS in T2DM with FMR. Conclusion FMR may aggravate the deterioration of LV stiffness in T2DM patients, resulting in decline of LV strain and function. The regurgitation degree and months with diabetes were independently correlated with LV global PS in T2DM with FMR.

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