The importance of subclinical left ventricular dysfunction and blood pressure pattern in asymptomatic type-2 diabetic patients: the diagnostic and prognostic significance of Tissue Doppler parameters, left ventricular global longitudinal strain, and nighttime blood pressure during sleep

Abstract

The primary aims of this study have been to explore the diagnostic and prognostic significance of Tissue Doppler parameters (TDI), global longitudinal strain (GLS), and blood pressure (BP) pattern in normotensive diabetic patients. MethodsThe study consisted of 121 diabetic patients and 41 healthy subjects. Conventional and TDI echocardiography were performed on all patients, including E/Em (ratio of diastolic velocities). GLS was derived from two-dimensional speckle-tracking. Ambulatory BP monitoring (ABPM) was obtained over 24h.Over the three year follow up, the end points were cardiac events (myocardial infarction, coronary revascularization procedures, new-onset angina, heart failure). ResultsGLS was found to be significantly lower (‐17.5±2.1vs-24.4±2.4; p<0.001), while E/Em was significantly higher (10.3±2.24vs7.4±1.8; p<0.001) in diabetic patients.A non-dipping pattern of BP was observed in 38 diabetic patients (31.4%); 14 diabetic patients had an increase in their nocturnal BP.Significant predictors of an adverse cardiac event: a reduction of GLS value (‐17%,p=0.05) increase in E/Em (>15, p=0.002) and systolic BP during nocturnal sleep (>119mmHg,p=0.020). ConclusionEarly detection of nocturnal hypertension and subclinical LV dysfunction by TDI and 2D spackle tracking are of significant clinical and prognostic importance.