Subclinical Systolic Myocardial Dysfunction in Diabetic Patients by 2-Dimensional Speckle Tracking

Abstract

Background: Diabetic cardiomyopathy became a subject of great interest and the evidence for this entity is rapidly emerging as the incidence of heart failure is increasing in those patients even with no hypertension or coronary artery disease (CAD). Objective: The current study was aimed at early detection of subtle left ventricular systolic dysfunction by speckle tracking echocardiography in patients with Diabetes Mellitus with and without hypertension. Patients and methods: This study included a total of 100 asymptomatic poorly controlled diabetic patients with or without hypertension and no structural heart disease and 25 age-matched apparently healthy control subjects attending at Cardiology department, Al-Azhar University Hospital in Damietta. The included subjects were divided into three groups; Group I (control) consisted of 25 apparently healthy subjects, Group II (diabetic normotensive group) consisted of 64 patients and Group III (diabetic hypertensive) consisted of 36 patients. The following were done for all: resting ECG, HbA1c, conventional echo assessment and finally strain imaging with measurement of LV-GLS and LV-GCS. Results: There was a significant inverse correlation between the duration diabetes, BMI and LV-GLS. On the other hand, there was no significant correlation between hypertension or HbA1c and echocardiographic parameters including conventional and strain methods. Patients with higher BMI had more decrease in LV circumferential strain while patients with longer periods of DM and higher values of BMI had a decrease on both global LV longitudinal and circumferential strains. Conclusion: It could be concluded that assessment of left ventricular (LV) systolic function in patients with diabetes mellitus by speckle tracking echocardiographic modalities can detect subtle LV dysfunction earlier than conventional echocardiographic measures.