Abstract
BackgroundSubclinical left ventricular (LV) longitudinal myocardial systolic dysfunction occurs in patients with diabetes mellitus (DM) and preserved LV ejection fraction (LVEF), and is closely related to DM-related complications. However, the association of diabetic neuropathy (DN) with subclinical LV systolic longitudinal dysfunction in such patients has not been fully clarified.MethodsThe subjects of this study were 112 consecutive DM patients with preserved LVEF (all ≥50%) without coronary artery disease and overt heart failure (aged 59 ± 14 years; 60 women, 52 men). Global longitudinal strain (GLS) was determined as the average peak strain of 18 segments from the three standard apical views, and was expressed as an absolute value. DN was diagnosed by experienced diabetologists. Median, ulnar, and sural nerves were subjected to motor and sensory nerve conduction studies. F-wave latency was defined as the minimum F-wave latency after a total of 16 stimulations of the tibial nerve.ResultsForty-one (37%) patients were clinically diagnosed with DN. LV functions of DM patients with and without DN were similar except for GLS being significantly smaller in patients with than in patients without DN (18 ± 2% vs. 20 ± 2%, p < 0.001). It was noteworthy that, of the parameters for the nerve conduction study, only F-wave latency correlated with GLS (r = −0.34, p < 0.001), and also was identified as an independent determinative value of GLS in a multivariate linear regression model (β = −0.25, p = 0.001) even after adjustment for other closely related GLS factors.ConclusionsMonitoring of F-wave latency may aid early detection of not only DN but also subclinical LV dysfunction. Joint planning of assessment by diabetologists and cardiologists is therefore advisable for better management of DM patients.
Highlights
Subclinical left ventricular (LV) myocardial dysfunction occurs in patients with diabetes mellitus (DM) and preserved LV ejection fraction (LVEF) but without coronary artery disease or hypertension [1,2,3]
LV longitudinal myocardial systolic dysfunction may constitute the first marker of a preclinical form of diabetic cardiomyopathy in DM patients with preserved LVEF without overt heart failure (HF) [4]
It has been reported that DM-related complications or patient characteristics such as diabetic nephropathy, diabetic retinopathy, obesity, insulin resistance, or autonomic neuropathy are associated with subclinical LV myocardial dysfunction, because all of them are considered to be accumulative phenotypes of poor metabolic control [11,12,13,14,15,16,17]
Summary
Subclinical left ventricular (LV) myocardial dysfunction occurs in patients with diabetes mellitus (DM) and preserved LV ejection fraction (LVEF) but without coronary artery disease or hypertension [1,2,3]. This condition is considered a major contributor to the development of a type of heart failure (HF) known as diabetic cardiomyopathy. Uncontrolled hyperglycemia generates microvascular ischemia, which results in peripheral nerve damage due to vasoconstriction and microvasculopathy [18] This mechanism of DN is the same as that of diabetic cardiomyopathy, the relationship of diabetic peripheral neuropathy with impaired LV longitudinal myocardial systolic function has not yet been fully clarified. The association of diabetic neuropathy (DN) with subclinical LV systolic longitudinal dysfunction in such patients has not been fully clarified
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