Resting Left Ventricular Global Longitudinal Strain to Identify Silent Myocardial Ischemia in Asymptomatic Patients with Diabetes Mellitus

Aims: The aim of the study was to evaluate the independent role of left ventricular systolic function in terms of global longitudinal strain, and diastolic function expressed as the ratio between early diastolic transmitral flow- and mitral annular motion velocities (E/é) in predicting cardiovascular events in patients with diabetes mellitus type 2. Methods: We prospectively investigated 406 consecutive patients, aged 55-65 years, with diabetes mellitus, who participated in the CARDIPP study. Echocardiography, carotid intima media thickness, carotid-femoral pulse wave velocity, pulse pressure measurement (pp) and glycosylated hemoglobin (HbA1c) were analysed. Results: Twelve cases of myocardial infarction and seven cases of stroke were identified during the follow-up period of 67 ± 17 months. Univariate Cox regression analysis showed that E/é was a strong predictor of cardiovascular events (HR 1.12; 95 % CI 1.06 to 1.18, p < 0.001) and in a multivariate analysis E/é was prospectively associated with cardiovascular events independent of age, sex, global longitudinal strain, pulse wave velocity, carotid intima media thickness, pp and HbA1c. The addition of HbA1c and pp to E/é increased the predictive value of the model significantly, [(E/é vs. E/é + HbA1c vs. E/é + HbA1c + pp) χ 2 = 18.1 vs. χ 2 = 23.0 vs. χ 2 =30.0, p = 0.030 vs. p = 0.007], but global longitudinal strain did not. An elevated E/é ratio, defined as > 15, was also predictive of major cardiovascular events in a Kaplan-Meyer analysis. The cumulative probability of the development of an event during the follow-up period for patients with an E/é ratio > 15 was 8.6 % compared with 2.6 % for patients E/é ratio ≤ 15, p = 0.021. Conclusion: Left ventricular diastolic dysfunction expressed as E/é is a strong predictor of myocardial infarction and stroke in middle-aged patients with diabetes mellitus, superior to global longitudinal strain, arterial stiffness and carotid intima media thickness.

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P1391 Global longitudinal strain in chronic asymptomatic aortic regurgitation: a meta-analysis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.824 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

D De Campos ◽

R Teixeira ◽

A Botelho ◽

C Saleiro ◽

J Lopes ◽

...

Keyword(s):

Aortic Regurgitation ◽

Longitudinal Strain ◽

Meta Analysis ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Symptom Development ◽

Ventricular Ejection Fraction ◽

Asymptomatic Patients ◽

All Cause Mortality

Abstract BACKGROUND Previous studies have shown that left ventricle global longitudinal strain (GLS) assessed with 2D-speckle tracking echocardiography, is an independent predictor of outcome in asymptomatic moderate to severe chronic aortic regurgitation (AR) patients. OBJECTIVES To assess GLS impact on mortality and need for aortic valve replacement (AVR) or symptom development in chronic asymptomatic AR patients and preserved left ventricular ejection fraction (LVEF). METHODS A literature search was performed according with these key terms "aortic regurgitation" and "longitudinal strain." The primary endpoint was all-cause mortality. Secondary end-points were: a composite of all-cause mortality, need for AVR or symptom development; and only AVR plus symptom development. Data was pooled using random-effects meta-analysis models. Pooled Hazard Ratio (HR) was performed using its log transformation and inverse variances as weights were then calculated for each study . RESULTS Six studies were included, with a total of 1,571 asymptomatic patients with at least moderate AR and preserved LVEF. There were 996 events (death, AVR, symptom development) reported during follow-up. Pooled adjusted mortality HR tended to be higher for patients with worse GLS (1.14 [0.96–1.35], P = 0.13, I2 51%). GLS performed better in predicting AVR or symptom development (mean difference -0.72 [-1.29, -0.15], P = 0.01, I2 88%), with an estimated HR of 1.36 ([1.01–1.84], P = 0.04, I2 65%). CONCLUSIONS In asymptomatic chronic moderate to severe AR patients, impaired GLS was associated with adverse cardiac outcomes. Left ventricular GLS may offer incremental value on risk stratification as well as on decision-making. Abstract P1391 Figure 1

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Exercise Stress Tests for Detecting Myocardial Ischemia in Asymptomatic Patients With Diabetes Mellitus

The American Journal of Cardiology ◽

10.1016/j.amjcard.2013.02.047 ◽

2013 ◽

Vol 112 (1) ◽

pp. 14-20 ◽

Cited By ~ 14

Author(s):

Fadi G. Hage ◽

Lara Lusa ◽

Maurizio Dondi ◽

Raffaele Giubbini ◽

Ami E. Iskandrian

Keyword(s):

Diabetes Mellitus ◽

Myocardial Ischemia ◽

Exercise Stress ◽

Stress Tests ◽

Asymptomatic Patients ◽

Patients With Diabetes

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Silent myocardial ischemia in asymptomatic patients with type 2 diabetes mellitus without previous histories of cardiovascular disease

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.04.008 ◽

2016 ◽

Vol 216 ◽

pp. 151-155 ◽

Cited By ~ 4

Author(s):

Yuki Kawano ◽

Masao Takemoto ◽

Takahiro Mito ◽

Hiroko Morisaki ◽

Atsushi Tanaka ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Type 2 Diabetes Mellitus ◽

Myocardial Ischemia ◽

Silent Myocardial Ischemia ◽

Asymptomatic Patients

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Three‐Dimensional Global Left Ventricular Myocardial Strain Reduced in All Directions in Subclinical Diabetic Cardiomyopathy: A Systematic Review and Meta‐Analysis

Journal of the American Heart Association ◽

10.1161/jaha.121.020811 ◽

2021 ◽

Author(s):

Seyed‐Mohammad Ghoreyshi‐Hefzabad ◽

Prajith Jeyaprakash ◽

Alpa Gupta ◽

Ha Q. Vo ◽

Faraz Pathan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Longitudinal Strain ◽

Circumferential Strain ◽

Meta Analysis ◽

Global Longitudinal Strain ◽

Three Dimensional ◽

Significant Heterogeneity ◽

Global Circumferential Strain ◽

Patients With Diabetes

Background Three‐dimensional (3D) speckle tracking echocardiography can identify subclinical diabetic cardiomyopathy without geometric assumption and loss of speckle from out‐of‐plane motions. There is, however, significant heterogeneity among the previous reports. We performed a systematic review and meta‐analysis to compare 3D strain values between adults with asymptomatic, subclinical diabetes mellitus (ie, patients with diabetes mellitus without known clinical manifestations of cardiac disease) and healthy controls. Methods and Results After systematic review of 5 databases, 12 valid studies (544 patients with diabetes mellitus and 489 controls) were eligible for meta‐analysis. Pooled means and mean difference (MD) using a random‐effects model for 3D global longitudinal, circumferential, radial, and area strain were calculated. Patients with diabetes mellitus had an overall 2.31 percentage points lower 3D global longitudinal strain than healthy subjects (16.6%, 95% CI, 15.7–17.6 versus 19.0; 95% CI, 18.2–19.7; MD, −2.31, 95% CI, −2.72 to −2.03). Similarly, 3D global circumferential strain (18.9%; 95% CI, 17.5–20.3 versus 20.5; 95% CI, 18.9–22.1; MD, −1.50; 95% CI, −2.09 to −0.91); 3D global radial strain (44.6%; 95% CI, 40.2–49.1 versus 48.2; 95% CI, 44.7–51.8; MD, −3.47; 95% CI, −4.98 to −1.97), and 3D global area strain (30.5%; 95% CI, 29.2–31.8 versus 32.4; 95% CI, 30.5–34.3; MD, −1.76; 95% CI, −2.74 to −0.78) were also lower in patients with diabetes mellitus. Significant heterogeneity was noted between studies for all strain directions (inconsistency factor [I 2 ], 37%–78%). Meta‐regression in subgroup analysis of studies using the most popular vendor found higher prevalence of hypertension as a significant contributor to worse 3D global longitudinal strain. Higher hemoglobulin A 1c was the most significant contributor to worse 3D global circumferential strain in patients with diabetes mellitus. Conclusions Three‐dimensional myocardial strain was reduced in all directions in asymptomatic diabetic patients. Hypertension and hemoglobin A 1c were associated with worse 3D global longitudinal strain and 3D global circumferential strain, respectively. Registration URL: https://www.crd.york.ac.uk/prospero ; unique identifier: CRD42020197825.

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Subtle decline in cardiac mechanics is correlated with albuminuria in asymptomatic normotensive patients with type 2 diabetes mellitus: a two-dimensional strain echocardiography study

10.21203/rs.3.rs-30939/v1 ◽

2020 ◽

Author(s):

Sameh Samir Raafat ◽

Nour Eldin M. Nazmy ◽

Islam M. Bastawy ◽

Yasser A. Abdellatif

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Longitudinal Strain ◽

Systolic Dysfunction ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Creatinine Ratio ◽

Albumin Creatinine Ratio

Abstract Background: Type 2 diabetes mellitus (T2DM) insidiously affects the myocardium with subsequent cardiomyopathy, it also pathologically involves the microvascular bed of the kidney reflected by albuminuria. This study aimed to investigate the relation between albuminuria and subclinical left ventricular (LV) systolic dysfunction in asymptomatic normotensive patients with T2DM assessed by two-dimensional (2D) speckle tracking echocardiography.Methods and results Sixty normotensive patients with T2DM, within 5 years of initial diagnosis, receiving conventional oral antidiabetic medications were included and subdivided into 2 subgroups, each including thirty patients according to the presence of albuminuria, together with thirty healthy control subjects all underwent full echocardiographic examination including left ventricular (LV) regional and global longitudinal strain (GLS) measurements. Laboratory tests including serum creatinine, glycated hemoglobin (HbA1C) and albumin creatinine ratio (ACR) were withdrawn for the three groups. There was a significant reduction in average peak systolic LV global longitudinal strain (GLS) in patients with T2DM when compared to control group (-16.18 ± 2.78% versus -18.13 ± 2.86%, P<0.001), however there was no significant difference in average peak systolic LV GLS between both diabetic subgroups (-15.57 ± 2.77% in subgroup with albuminuria versus -16.79 ± 2.70% in subgroup without albuminuria, p=0.077). Moreover, there was a significant correlation between ACR and reduction of GLS in patients with T2DM and albuminuria (r =0.38, P=0.003). However, this correlation was absent in patients with T2DM without albuminuria (r=0.107, P=0.573). Conclusion: Patients with type 2 diabetes mellitus (T2DM) have subclinical LV systolic dysfunction despite normal ejection fraction through reduction of average peak systolic LV GLS that is correlated with albumin creatinine ratio in patients with T2DM and albuminuria.

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Asymptomatic cardiovascular manifestations in diabetes mellitus: Left ventricular diastolic dysfunction and silent myocardial ischemia

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1110599s ◽

2011 ◽

Vol 139 (9-10) ◽

pp. 599-604

Author(s):

Jelena Seferovic-Mitrovic ◽

Nebojsa Lalic ◽

Bosiljka Vujisic-Tesic ◽

Katarina Lalic ◽

Aleksandra Jotic ◽

...

Keyword(s):

Type 2 Diabetes ◽

Myocardial Ischemia ◽

Diastolic Dysfunction ◽

Tissue Doppler ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Silent Myocardial Ischemia ◽

Ventricular Diastolic Dysfunction ◽

Patients With Diabetes

Introduction. Several cardiovascular manifestations in patients with diabetes may be asymptomatic. Left ventricular diastolic dysfunction (LVDD) is considered to be the earliest metabolic myocardial lesion in these patients, and can be diagnosed with tissue Doppler echocardiography. Silent myocardial ischemia (SMI) is a characteristic and frequently described form of ischemic heart disease in patients with diabetes. Objective. The aim of the study was to assess the prevalence of LVDD and SMI in patients with type 2 diabetes, as well as to compare demographic, clinical, and metabolic data among defined groups (patients with LVDD, patients with SMI and patients with type 2 diabetes, without LVDD and SMI). Methods. We investigated 104 type 2 diabetic patients (mean age 55.4?9.1 years, 64.4% males) with normal blood pressure, prehypertension and arterial hypertension stage I. Study design included basic laboratory assessment and cardiological workup (transthoracic echocardiography and tissue Doppler, as well as the exercise stress echocardiography). Results. LVDD was diagnosed in twelve patients (11.5%), while SMI was revealed in six patients (5.8%). Less patients with LVDD were using metformin, in comparison to other two groups (?2 =12.152; p=0.002). Values of HDL cholesterol (F=4.515; p=0.013) and apolipoprotein A1 (F=5.128; p= 0.008) were significantly higher in patients with LVDD. Conclusion. The study confirmed asymptomatic cardiovascular complications in 17.3% patients with type 2 diabetes.

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Incremental value of diastolic stress test in identifying subclinical heart failure in patients with diabetes mellitus

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa070 ◽

2020 ◽

Vol 21 (8) ◽

pp. 876-884 ◽

Cited By ~ 4

Author(s):

Tomoko Nishi ◽

Yukari Kobayashi ◽

Jeffrey W Christle ◽

Nicholas Cauwenberghs ◽

Kalyani Boralkar ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Diastolic Dysfunction ◽

Stress Test ◽

Left Ventricular ◽

Metabolic Equivalents ◽

Incremental Value ◽

Asymptomatic Patients ◽

Patients With Diabetes ◽

Male Sex

Abstract Aims Resting echocardiography is a valuable method for detecting subclinical heart failure (HF) in patients with diabetes mellitus (DM). However, few studies have assessed the incremental value of diastolic stress for detecting subclinical HF in this population. Methods and results Asymptomatic patients with Type 2 DM were prospectively enrolled. Subclinical HF was assessed using systolic dysfunction (left ventricular longitudinal strain <16% at rest and <19% after exercise in absolute value), abnormal cardiac morphology, or diastolic dysfunction (E/e′ > 10). Metabolic equivalents (METs) were calculated using treadmill speed and grade, and functional capacity was assessed by percent-predicted METs (ppMETs). Among 161 patients studied (mean age of 59 ± 11 years and 57% male sex), subclinical HF was observed in 68% at rest and in 79% with exercise. Among characteristics, diastolic stress had the highest yield in improving detection of HF with 57% of abnormal cases after exercise and 45% at rest. Patients with revealed diastolic dysfunction during stress had significantly lower exercise capacity than patients with normal diastolic stress (7.3 ± 2.1 vs. 8.8 ± 2.5, P < 0.001 for peak METs and 91 ± 30% vs. 105 ± 30%, P = 0.04 for ppMETs). On multivariable modelling found that age (beta = −0.33), male sex (beta = 0.21), body mass index (beta = −0.49), and exercise E/e′ >10 (beta = −0.17) were independently associated with peak METs (combined R2 = 0.46). A network correlation map revealed the connectivity of peak METs and diastolic properties as central features in patients with DM. Conclusion Diastolic stress test improves the detection of subclinical HF in patients with diabetes mellitus.

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P1594 Relationship between left ventricular morphology and systolic performance and coronary microcirculatory dysfunction in hypertrophic cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1012 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Aguiar Rosa ◽

L Branco ◽

A Galrinho ◽

A Fiarresga ◽

L Lopes ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Myocardial Ischemia ◽

Coronary Flow ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Coronary Flow Velocity ◽

Microcirculatory Dysfunction ◽

Maximal Wall Thickness ◽

Systolic Performance

Abstract Background Myocardial ischemia constitutes one of the most important pathophysiological features in hypertrophic cardiomyopathy (HCM). Chronic and recurrent myocardial ischemia leads to fibrosis, which may culminate in myocardial dysfunction. Objective To analyse the relationship between left ventricular (LV) morphology and systolic performance and coronary microcirculatory dysfunction in HCM. Methods The present study prospectively included HCM patients (P) who underwent transthoracic echocardiography. Left ventricular (LV) function was evaluated by ejection fraction (LVEF), global longitudinal strain (GLS) and tissue Doppler septal and lateral s’. The evaluation of coronary flow velocity reserve (CFVR) was performed in apical three chambers view for the left anterior descending (LAD) artery and in an apical three chambers view for the posterior descending (PD) artery. Diastolic coronary flow velocity was measured in basal conditions and in hyperemia, induced by adenosine perfusion (0.14 mg/kg/min intravenously, during 2 minutes). Absolute CFVR was calculated as the ratio of hyperemic to basal peak diastolic flow velocities; relative CFVR was calculated as the ratio between CFVR LAD and CFVR PD. Results 23 P were enrolled (57% male, mean age 57.9 ± 13.7 years). Asymmetric septal hypertrophy was verified in 70% of P, with maximal wall thickness of 21.6 ± 4.3mm. Obstructive HCM was documented in 35% of patients. CFV was successfully measured in the LAD in all patients, but only in 70% of patients in the PD due to technical issues related to poor acoustic window and anatomical constraints. 78% of P (n = 18) presented CFVR <2, denoting microcirculatory dysfunction. Relative CFVR (LAD CFVR/ PD CFVR) was ≥1 in 43% of P. P with maximal wall thickness (MWT)>20mm presented higher CFV PD at baseline (46.5 ± 17.4 vs 32.5 ± 12.6 cm/s; p = 0.072), lower CFVR PD (1.3 ± 0.3 vs 2.5 ± 0.8; p = 0.003) and greater regional difference of microcirculation (relative CFVR 1.4 ± 0.6 vs 0.8 ± 0.3; p = 0.048). At baseline conditions, CFV LAD was higher in obstructive HCM (44.0 ± 4.8 vs 35.3 ± 10.6 cm/s; p = 0.040). P with impairment in global longitudinal strain (GLS>-18%) had higher basal CFV LAD (40.1 ± 8.6 vs 30.0 ± 12.2 cm/s; p = 0.059) and PD (44.5 ± 15.2 vs 20.0 ± 5.0 cm/s; p = 0.015) but lower CFVR PD (1.5 ± 0.5 vs 2.8 ± 1.1; p = 0.039). The reduction in CFVR PD was also noted in P with time to peak longitudinal strain dispersion >90mseg (CFVR PD 1.2 ± 0.2vs1.9 ± 0.9;p = 0.012). Conclusion Higher CFV at baseline was noted in P with greater MWT, obstructive HCM and worse GLS. Coronary microcirculatory dysfunction was associated with the degree of LV hypertrophy and impairment in LV systolic performance.

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