Abstract
The aim of this study was to employ phase analysis to diagnose left ventricular mechanical dyssynchrony (LVMD) in asymptomatic patients with diabetes mellitus type 2 and normal perfusion study which may help prevent diabetic cardiomyopathy. Ninety-three consecutive patients with known type 2 diabetes and 81 age- and gender- matched patients without diabetes who were candidates for SPECT-MPI were considered as the control group. The presence of LVMD as an possible risk factor for cardiomyopathy- was determined using phase analysis for each scan with quantitative gated SPECT (QGS) and corridor4DM (4DM) software. All outcomes such as phase bandwidth (PBW) and phase standard deviation (PSD) were compared between the two groups. A total of 174 patients were included in the study. There were no statistically significant difference regarding demographic factors between the two groups (P > 0.05). PBW showed statistically significant differences (increased in diabetics) between the control and diabetic patients (P < 0.05). Kruskal Wallis analysis revealed that as the duration of diabetes is prolonged, especially more than 15years, the probability of LVMD is increased as well (P = 0.021). Fraction of asymptomatic diabetic patients with normal ejection fraction and gated SPECT MPI-especially those with prolonged diabetes- might have some degrees of LVMD. Phase analysis can detect this which in turn may prevent progress into heart failure.
Highlights
Diabetes is the most common human metabolic disease and its incidence is increasing in different societies [1,2,3]
Diabetic cardiomyopathy (DCM) was first described by Rubler et al indicating a wide range of pathologic changes in the myocardium of diabetic patients [4, 5]
DCM would lead to a preclinical left ventricular diastolic dysfunction, which might develop to a clinical heart failure without any evident coronary artery disease or valvular involvement [8,9,10]
Summary
Diabetes is the most common human metabolic disease and its incidence is increasing in different societies [1,2,3]. Underlying reasons for diabetic cardiomyopathy include increased oxidative stress, mitochondrial dysfunction, impairment in calcium handling and extracellular matrix remodeling which lead to a defect in myocardial contractility and DCM progression [6, 7]. DCM would lead to a preclinical left ventricular diastolic dysfunction, which might develop to a clinical heart failure without any evident coronary artery disease or valvular involvement [8,9,10]. Korosoglou et al described left ventricular mechanical dyssynchrony (LVMD) in patients with DM even without any signs for LV diastolic dysfunction. They indicated that LVMD could occur as the first pathologic changes during the course of diabetic cardiomyopathy [11]
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