Abstract
In-depth understanding of early cardiovascular manifestations in diabetes is high on international research and prevention agendas given that cardiovascular events are the leading cause of death for diabetic patients. Our aim was to review recent developments in the echocardiographic assessment of left ventricular diastolic dysfunction (LVDD) as a telltale pre-clinical disturbance preceding diabetic cardiomyopathy. We analyzed papers in which patients had been comprehensively assessed echocardiographically according to the latest LVDD guidelines (2016), and those affording comparisons with previous, widely used recommendations (2009). We found that the updated algorithm for LVDD is more effective in predicting adverse cardiovascular events in patients with established LVDD, and less specific in grading other patients (labelled “indeterminate”). This may prove instrumental for recruiting “indeterminate” LVDD cases among patients with type 2 diabetes mellitus (T2DM) in future screening programs. As an interesting consideration, the elevated values of the index E/e’ can point to early diastolic impairment, foretelling diabetic cardiomyopathy. Identifying subclinical signs early makes clinical sense, but the complex nature of T2DM calls for further research. Specifically, longitudinal studies on rigorously selected cohorts of diabetic patients are needed to better understand and predict the subtle, slow onset of cardiac manifestations with T2DM as a complicating backdrop.
Highlights
The undisputed bidirectional relationship between type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) acts as a vicious circle, whereby the former heightens the risk of the latter, and the latter is an important complication, comorbidity, and mortality factor in the former [1,2]
T2DM patients over a period of 10 years) concluded that almost a third of type 2 diabetic patients suffer from some form of CVD
The most widely known, applied, and reviewed set of recommendations for assessing diastolic function is the guideline for the evaluation of left ventricular diastolic function by means of echocardiography, available since 2009 [9]
Summary
The undisputed bidirectional relationship between type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) acts as a vicious circle, whereby the former heightens the risk of the latter, and the latter is an important complication, comorbidity, and mortality factor in the former [1,2]. This is all the more worrying as both are increasingly prevalent worldwide. Type 2 diabetic patients may develop underlying CVD without experiencing or recognizing the telltale signs and symptoms until too late. Subclinical manifestations are difficult to Diagnostics 2019, 9, 121; doi:10.3390/diagnostics9030121 www.mdpi.com/journal/diagnostics
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