Clinical features of subclinical left ventricular systolic dysfunction in patients with diabetes mellitus

Cardiovascular Diabetology

Ken-ichi Hirata²  Wataru Ogawa¹  Yushi Hirota¹  Keiko Ryo²  Yoshiki Motoji²  Takuma Sawa²  Junichi Ooka²  Hiroyuki Shimoura²  Hiromi Toki²  Hiroyuki Sano²  Kensuke Matsumoto²  Hidekazu Tanaka²  Yasuhide Mochizuki² 

[1] Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan;Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Kobe 650-0017, Chuo-ku, Japan

关键词: Global longitudinal strain;    Two-dimensional speckle-tracking strain;    Echocardiography;    Albuminuria;    Nephropathy;    Diabetes mellitus;   

Others  :  1177363
DOI  :  10.1186/s12933-015-0201-8

 received in 2015-01-28, accepted in 2015-03-14,  发布年份 2015

【 摘 要 】

Background

Left ventricular (LV) longitudinal systolic dysfunction has been identified even in asymptomatic patients with diabetes mellitus (DM) and preserved LV ejection fraction (LVEF). However, its relevant clinical features have not been fully evaluated.

Methods

We studied 144 asymptomatic DM patients without coronary artery disease. Their mean age was 57 ± 15 years, 79 (55%) were female, and mean LVEF was 66 ± 4% (all ≥50%). Global longitudinal strain (GLS) was determined as the average peak strain of 18 segments from the three standard apical views, and was expressed as an absolute value. With the pre-defined cutoff for subclinical LV systolic dysfunction in DM patients with preserved LVEF set at GLS < 18%, this dysfunction was detected in 53 patients (37%).

Results

Multivariate logistic regression analysis revealed that type 2 DM, hypertriglyceridemia, overweight/obesity, nephropathy and neuropathy were independently associated with GLS < 18%, with nephropathy being the highest risk factor (OR: 5.26; 95% CI 2.111-13.12, p < 0.001). For sequential logistic regression models, a model based on clinical variables including gender, type 2 DM and DM duration (χ² = 24.1) was improved by addition of overweight/obesity and hypertriglyceridemia (χ² = 45.6, p < 0.001), and further improved by addition of nephropathy and neuropathy (χ² = 70.2, p < 0.001) as variables. Furthermore, albuminuria significantly correlated with GLS (r = −0.51, p < 0.001), and a multivariate regression model showed it to be the factor most closely associated with GLS (β = −0.33, p < 0.001).

Conclusions

Diabetic complications, hypertriglyceridemia and overweight/obesity were closely associated with early stage of LV systolic longitudinal myocardial dysfunction in asymptomatic DM patients with preserved LVEF. Our findings can be clinically noticeable for the management of DM patients.

【 授权许可】

   
2015 Mochizuki et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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Figure 3.

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