Postexercise stunning in type II diabetes mellitus assessed by 2D speckle tracking echocardiography and gated-SPECT myocardial perfusion imaging

Abstract

Background Type II diabetes mellitus (DM) is usually associated with a number of myocardial structural and functional changes. Noninvasive imaging techniques play a key role in the identification of these changes. Objective Detection of postexercise myocardium stunning in type II DM patients by 2 dimensional speckle tracking Echo (2D STE) and single photon emission computed tomography (SPECT) imaging. Patients and methods The authors enrolled 60 symptomatic patients with type II DM who were classified into different groups: Group I included 17 patients with normal left ventricular global longitudinal strain (LVGLS) and negative SPECT; group II included 43 patients with impaired LVGLS and negative SPECT; and group III included 10 patients with impaired LVGLS and positive SPECT. The authors evaluate LV functions and dimensions before and early after exercise by conventional, tissue Doppler, 2D STE, and gated-SPECT perfusion imaging. Coronary angiography for group III. Results This study shows statistically significant difference between early and late gated SPECT regarding left ventricular end diastolic volume (LVEDV) and EF% between the three different groups. There were significant decrease in average LVGLS from (−20.79±1.04 pre-exercise) vs (−16.15±1.28 postexercise) in group I from (−15.98±1.75 pre-exercise) vs (−14±2.47 postexercise) in group II and from (−15.82±3.44 pre-exercise) vs (−13.48±2.75 postexercise) in group III. Eight out of 10 patientﹶs had coronary artery disease in group III. Conclusion Transient ischemic stunning and dilatation remained a robust marker for high-risk scan especially in type II DM. LVGLS correlated well with gated SPECT in the detection of postexercise LV stunning. LVGLS is a very sensitive parameter and paramount for early detection of LV subclinical systolic dysfunction in diabetic patients.