Possibilities of speckle-tracking echocardiography in diagnostic of diastolic dysfunction at the preclinical stage in obese patients

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Currently, it is shown that the prevalence of diastolic dysfunction is extremely high. However, with the help of traditional echocardiography (ECG) indicators, it is not possible to detect diastolic dysfunction at the preclinical stage. Therefore, it is important to search for new non-invasive methods for the diagnostic of myocardial fibrosis, as an equivalent of diastolic dysfunction, at an early stage to prevent progression in HF. Objective to study the relationship of left ventricular (LV) mechanics with the level of serum markers of myocardial fibrosis in patients with epicardial obesity (EO). Materials and methods The study included 110 men with general obesity. According to the results of echocardiography (ECG), patients were divided into 2 groups: EO (+) with epicardial fat thickness (tEAT) ≥7 mm (n = 70); EO (-) with tEAT < 7 mm (n = 40) without diastolic dysfunction according to the results of ECG. Profibrotic markers in blood serum (MMP-3, collagen I, collagen III, TGF – β, VEGFA, PICP) were determined in all patients using enzyme immunoassay. Using speckle-tracking echocardiography, the mechanics of LV were studied (twist LV, peak twist ratio LV, time to peak twist of LV, peak untwist ratio LV, time to peak untwist of LV). The exclusion criteria were the presence of coronary pathology, arterial hypertension, and type 2 diabetes mellitus. Results In the group of patients with EO ( + ) statistically significant increase the level of all studied profibrotic markers was revealed. According to the results of speckle-tracking ECG in the EO (+) group an increase peak untwist ratio LV to -128.31 (-142.0; -118.0) deg/s-1 (p = 0.002) and an increase time to peak untwist of LV of 476.44 (510.0; 411.0) msec was determined in comparison with the EO ( - ) group (p = 0.03). A weak statistically significant effect of tEAT on the peak untwist ratio LV in EO (+) group was revealed (r = 0.24; p = 0.04). In addition, there was a significant relationship between peak untwist ratio LV and markers of myocardial fibrosis MMP-3 (r = 0,21; p = 0.04) and collagen type III (r = 0,26; p = 0.03). Conclusion Given the presence of increasing serum levels of profibrotic factors, we can assume that in patients with EO, there is preclinical diastolic dysfunction LV, identification of which is possible with the help of determining peak untwist ratio LV, time to peak untwist of LV.