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

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 Laboratory tests including serum creatinine, glycated hemoglobin (HbA1C) and albumin creatinine ratio (ACR) were withdrawn for the three groups.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.

scholarly journals The relative apical sparing pattern is common in elderly patients with type 2 diabetes mellitus

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Uneno
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiac Function ◽  
Cardiac Amyloidosis ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular

Abstract Background Type 2 diabetes mellitus (T2DM) impairs cardiac function and is one of the risk factors for heart failure. However, the mechanism of cardiac impairment is not elucidated. Despa et al. reported that amylin has aggregation properties similar to amyloidogenic proteins and impairs cardiac function in T2DM patients with hyperamylinemia. In this hypothesis, T2DM-induced myocardial impairment is thought of as amylin-induced cardiac amyloidosis. The purpose of this study is to clarify whether a relative apical sparing pattern (RASP), which is well known as a typical pattern of cardiac amyloidosis, is common in T2DM. Methods We studied patients aged 75 years or over who underwent echocardiography from January 2018 to December 2020 in our clinic. We calculated the quantitative relative apical sparing (qRASP) as average apical-longitudinal strain (LS)/(average basal-LS + average mid-LS) in each patient. According to the validated threshold, a qRASP ≥1.0 was defined as an obvious RASP (oRASP). We compared the ratio of oRASP between patients with and without T2DM. Results We researched 506 patients, mean 81.8 years, 290 females, 133 with T2DM. The average age, atrial fibrillation rate, heart failure rate, and hypertension rate were similar in both groups. The ratio of ischemic heart disease was higher in the T2DM group. Echocardiography showed that the left atrial dimension (LAD), E/e', and left ventricular hypertrophy (LVH) ratio was higher in the T2DM group. Speckle tracking echocardiography revealed that global longitudinal strain (GLS) and qRASP of the T2DM group were higher than the non-DM group (GLS;-18.0% vs. −19.2%, p&lt;0.001. qRASP; 0.809 vs. 0.699, P&lt;0.001). Furthermore, the ratio of oRASP was significantly higher in the T2DM group (19.0% vs. 1.34%, p&lt;0.001). Multivariable logistic regression analysis showed T2DM was an independent predictor for oRASP. Conclusion This study revealed that the qRASP and the ratio of oRASP in the T2DM group were higher than non-DM group. This finding supports the hypothesis that T2DM related cardiomyopathy is a kind of cardiac amyloidosis caused by amylin. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals P979 Subclinical left ventricular dysfunction and silent myocardial ischemia in asymptomatic middle-aged patients with type 2 diabetes mellitus

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Kisko ◽  
J Lesko ◽  
L Dernarova ◽  
N Kishko
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Male Gender ◽  
Silent Myocardial Ischemia ◽  
Middle Aged ◽  
Aged Patients

Abstract Early detection of silent myocardial ischemia (SMI) in asymptomatic middle-aged patients (pts) with type 2 diabetes mellitus (T2DM) may be important due to the generally poor prognosis and early myocardial involvement in this specific subgroup of diabetic population. Our goal was to evaluate whether subclinical left ventricular (LV) systolic dysfunction assessed by two-dimensional speckle-tracking echocardiography (2D-STE) is independently related to SMI detected by MPI (gated SPECT myocardial scintigraphy) and if it could provide incremental information over baseline characteristics to identify it. We have tested the hypothesis that the myocardial mechanics significantly differ in asymptomatic middle-aged diabetics, depending on the presence or absence of SMI. In total, 60 consecutive middle-aged (&lt;60 years; 42 males, 70.0%) asymptomatic T2DM pts were enrolled into the study. MPI was performed in one-day protocol according to the EANM procedural guidelines, and SMI was diagnosed consensually by two experts as myocardial perfusion abnormalities without associated symptoms. The T2DM pts were subdivided into two groups according to the results of MPI, namely SMI group (n = 11) and non-SMI group (n= 49) Global longitudinal peak systolic strain (GLPSS) was measured from two- and four-chamber views cines using Automated Function Imaging (Vivid S6, GE). Subclinical LV dysfunction was defined as GLPSS of &gt; -20%. Prevalence of SMI in T2DM pts was 18,3%. All pts in SMI group (n = 11) were of male gender, and disease duration ≥ 5 years. Pooled data from 2D-STE showed significant reduction in mean absolute GLPSS values (p&lt;.001). Further more, pts in SMI group had more impaired GLPSS when compared with patients in non-SMI group (-16.1 ± 1.5% vs. -20.4 ± 1.8%, P &lt; .01). At multivariate analysis, male gender, an amount of epicardial adipose tissue and erectile dysfunction in men were independently associated with SMI. The addition of the LV GLPSS values to other selected independent clinical variables significantly improved the ability to predict SMI in these patients (χ(2) = 48.62; P = .001). Asymptomatic middle-aged T2DM pts with SMI showed a more impaired LV GLPSS compared with patients without silent ischemia. The presence of subclinical LV systolic dysfunction provides significant incremental value for the identification of SMI in asymptomatic middle-aged diabetics.

scholarly journals The additive effects of type 2 diabetes mellitus on left ventricular deformation and myocardial perfusion in essential hypertension: a 3.0 T cardiac magnetic resonance study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Xue-Ming Li ◽  
Li Jiang ◽  
Ying-Kun Guo ◽  
Yan Ren ◽  
Pei-Lun Han ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Heart Rate ◽  
Type 2 Diabetes Mellitus ◽  
Cardiac Magnetic Resonance ◽  
Myocardial Perfusion ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Regression Analyses

Abstract Background Type 2 diabetes mellitus (T2DM) increases the risks of heart failure and mortality in patients with hypertension, however the underlying mechanism is unclear. This study aims to investigate the impact of coexisting T2DM on left ventricular (LV) deformation and myocardial perfusion in hypertensive individuals. Materials and methods Seventy hypertensive patients without T2DM [HTN(T2DM−)], forty patients with T2DM [HTN(T2DM+)] and 37 age- and sex-matched controls underwent cardiac magnetic resonance examination. Left ventricular (LV) myocardial strains, including global radial (GRPS), circumferential (GCPS) and longitudinal peak strain (GLPS), and resting myocardial perfusion indices, including upslope, time to maximum signal intensity (TTM), and max signal intensity (MaxSI), were measured and compared among groups by analysis of covariance after adjusting for age, sex, body mass index (BMI) and heart rate followed by Bonferroni’s post hoc test. Backwards stepwise multivariable linear regression analyses were performed to determine the effects of T2DM on LV strains and myocardial perfusion indices in patients with hypertension. Results Both GRPS and GLPS deteriorated significantly from controls, through HTN(T2DM−), to HTN(T2DM+) group; GCPS in HTN(T2DM+) group was lower than those in both HTN(T2DM−) and control groups. Compared with controls, HTN(T2DM−) group showed higher myocardial perfusion, and HTN(T2DM+) group exhibited lower perfusion than HTN(T2DM−) group and controls. Multiple regression analyses considering covariates of systolic blood pressure, age, sex, BMI, heart rate, smoking, indexed LV mass and eGFR demonstrated that T2DM was independently associated with LV strains (GRPS: p = 0.002, model R2= 0.383; GCPS: p < 0.001, model R2= 0.472; and GLPS: p = 0.002, model R2= 0.424, respectively) and perfusion indices (upslope: p < 0.001, model R2= 0.293; TTM: p < 0.001, model R2= 0.299; and MaxSI: p < 0.001, model R2= 0.268, respectively) in hypertension. When both T2DM and perfusion indices were included in the regression analyses, both T2DM and TTM were independently associated with GRPS (p = 0.044 and 0.017, model R2= 0.390) and GCPS (p = 0.002 and 0.001, model R2= 0.424), and T2DM but not perfusion indices was independently associated with GLPS (p = 0.002, model R2= 0.424). Conclusion In patients with hypertension, T2DM had an additive deleterious effect on subclinical LV systolic dysfunction and myocardial perfusion, and impaired myocardial perfusion by coexisting T2DM was associated with deteriorated LV systolic dysfunction.

scholarly journals MICROALBUMINURIA;

2017 ◽  
Vol 24 (02) ◽  
pp. 221-227
Author(s):  
Ghazanfar Ali Sandhu ◽  
Ghulam Abbas Tahir ◽  
Zaheer Ahmad ◽  
Aqeel Maqsood Anjum
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
T Test ◽  
Losartan Potassium ◽  
P Value ◽  
Creatinine Ratio ◽  
Albumin Creatinine Ratio ◽  
Significant Difference

Diabetes Mellitus is a rapidly increasing problem which is contributing tochronic illnesses like Cerebrovascular, Cardiovascular, Diabetic Retinopathy and End StageKidney Disease. These dreaded complications can be prevented if treated early. In patientswith diabetes mellitus type 2, microalbuminuria is an independent and strong risk factor forcardiovascular mortality & morbidity and diabetic nephropathy. If diagnosed early, diabeticnephropathy can be treated at this stage. Angiotensin converting enzyme inhibitors (ACEInhibitors) and Angiotensin Receptor Blockers (ARBs) are effective in prevention and treatmentof microalbuminuria. Material & Methods: Study Design: randomized controlled trial. Setting:medical department, allied hospital, Faisalabad. Duration of study: Feb 2013 to July 2013.Sample size: 60 (30 in each group). Sampling technique: Non-probability consecutivesampling. Results: 60 patients were included in the study. 28(46.7%) were males and 32(53.3%)were females. Mean age of study population was 50.15±7.27 years. Albumin creatinine ratio(mcg/mg) at start of study was 193±67.5 in Losartan potassium group and 209.5±72.00 inlisinopril group (independent sample t-test p value=0.302). Albumin creatinine ratio (mcg/mg) at 12 weeks of study was 36.33±54.68 in Losartan potassium group and 72±83.42 inlisinopril group (independent sample t-test p value = 0.056). Paired sample t test applied toboth treatment groups and p value was found to be 0.0001 which is highly significant for bothgroups and shows that both drugs are effective in reducing microalbuminuria in both groups.Microalbuminuria was reduced significantly in 26 patients (86.7%) in Losartan potassiumgroup and 20 patients (66.7%) in lisinopril group (p-value=0.067). Conclusion: It has beenconcluded from this study that lisinopril and Losartan potassium, both significantly reducemicroalbuminuria in type 2 diabetes mellitus and there is no statistically significant difference inefficacy of these two drugs in reducing microalbuminuria in type 2 diabetes mellitus.

scholarly journals Association of Serum Uric Acid with Biventricular Myocardial Dysfunction in Patients with type 2 Diabetes Mellitus: A Cross-sectional Study

2020 ◽  
Author(s):  
Ju-Hua Liu ◽  
Mei-Zhen Wu ◽  
Si-Min Li ◽  
Yan Chen ◽  
Qing-Wen Ren ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Left Ventricular

Abstract BackgroundIncreased serum uric acid (SUA) is common in patients with type 2 diabetes mellitus (T2DM) and is associated with left ventricular (LV) myocardial dysfunction. Nonetheless the association of SUA with right ventricular (RV) function in patients with T2DM has not been studied. This study aimed to investigate the association of SUA with biventricular myocardial function in patients with T2DM.MethodsA total of 560 patients with T2DM were enrolled and divided into four groups according to quartile of SUA. Transthoracic echocardiography was performed and two-dimensional speckle tracking used to measure biventricular myocardial strain, including LV global longitudinal strain (GLS), circumferential strain (CS), radial strain (RS), and RV free wall longitudinal stra in (RV-FWLS).Results The absolute value of all biventricular strain parameters showed a stepwise decrease across SUA quartiles (all P<0.01). In particular, LV assessment by GLS, CS and RS demonstrated that those in the 4th quartile were impaired compared with the other quartiles (all P<0.05). Similarly, RV-FWLS of the 4th quartile was significantly impaired compared with the 1st and 2nd quartiles (all P<0.05). The same reduction in biventricular strain across SUA quartiles was observed in patients with estimated glomerular filtration rate＜or ≥60 ml/min/1.73 m2, and glycated hemoglobin < or ≥7.0% (all P<0.05). Multivariable linear regression analysis demonstrated that higher quartile of SUA was independently associated with impaired biventricular myocardial strain (all P<0.05). ConclusionsSUA was independently associated with biventricular myocardial dysfunction in asymptomatic T2DM patients, regardless of renal function or diabetic control.

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