Longitudinal Left Ventricular Function in Normotensive Prediabetics: A Tissue Doppler and Strain/Strain Rate Echocardiography Study (original) (raw)
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Subclinical Diastolic Dysfunction in Diabetic Population
Macedonian Medical Review, 2016
Introduction. Left ventricular dysfunction is very frequent in asymptomatic diabetic population. Tissue Doppler Imaging (TDI) is a new echocardiographic technique, able to record early changes of left ventricular dysfunction and to identify asymptomatic diabetic patients at high risk of developing heart failure. Aim. To assess the role of TDI in early detection of diastolic dysfunction in asymptomatic diabetic patients. Methods. Cross-sectional study that involved a total number of 48 subjects. The target group consisted of 25 asymptomatic diabetic patients and control group was composed of 23 subjects without diabetes. All subjects underwent echocardiography (conventional 2D and Pulsed-Wave Doppler and contemporary-TDI) to analyze left ventricular function. We compared the results from both echo-techniques and analyzed the relation of echo-cardiographic parameters with risk factors. Results. We found statistically significant difference between TDI and PW Doppler (E/E'vs E/A) i...
Plasma Glucose Levels and Left Ventricular Diastolic Function in Nondiabetic Hypertensive Patients
American Journal of Hypertension, 2013
background Changes in left ventricular (LV) diastolic filling anticipate diastolic heart failure and are frequently detected in patients with hypertension or diabetes. We tested the hypothesis that increased fasting and postload glucose levels are associated with diastolic dysfunction as assessed by tissue Doppler imaging (TDI) in hypertensive patients.
Diastolic dysfunction has been described as an early sign of diabetic heart muscle disease preceding the systolic damage. The present study was taken up with an objective to evaluate systolic and diastolic dysfunction in asymptomatic normotensive type 2 diabetes mellitus patients. Left ventricular function was evaluated by m-mode, 2-D echo and colour Doppler studies was done in 50 cases and compared with 50 age-and sex-matched controls. All the investigations were within normal limits except mean Fasting blood glucose of 142 9.94 and post-prandial blood sugar of 226 18.61. In systolic function the mean ejection fraction (EF) was 63.12 6.19 and mean fractional shortening was 35.42 5.03. The EF was < 50% in 3 (6%) patients, but was asymptomatic. The mean E/A ratio was 0.95 0.10 and 26 (52%) had E/A ratio of < 1 as compared to 24 (48%) > 1%. The mean isovolumetric relaxation time was 87.94 20.36, and mean DT of E was 180.68 34.64. Left ventricular diastolic dysfunction (LVDD) is much more common than previously reported in subjects with well controlled type 2 diabetes mellitus that are free of clinically detectable heart disease.
DIASTOLIC DYSFUNCTION IN DIABETES MELLITUS
National Journal of Medical Research, 2013
Introduction: Diabetes Mellitus is a disease with multi-system complications. Congestive heart failure is the end result of cardiovascular complications, and is heralded by the presence of diabetic cardiomyopathy, indicated by diastolic left ventricular dysfunction, which can be easily assessed with echocardiography. Objectives: To note prevalence of LV diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Methods: A study was carried out on 50 diabetics and compared with 50 age and sex matched controls. In all the patients, detailed history, physical examination and specific investigations (conventional Doppler echocardiography at rest) were done to find out the prevalence of diastolic dysfunction. Results: The prevalence of diastolic dysfunction, defined by echocardiographic criteria was 66%. E/A, DT and peak A velocity were sensitive indices of diastolic LV dysfunction. Left ventricular hypertrophy, as indicated by an increased LV mass, was an early marker of diabetic cardiomyopathy. Conclusion: Echocardiography is a sensitive method to investigate for diastolic dysfunction. There is a high prevalence of diastolic dysfunction in diabetes, which is an early marker of diabetic cardiomyopathy.
Impact of diabetes and hypertension on left ventricular longitudinal systolic function
2010
a b s t r a c t Background: The assessment of the longitudinal component of left ventricular (LV) function is of major clinical importance for the early detection of LV contractile impairment. The aim of this study was to compare the impact of isolated type-2 diabetes, isolated hypertension, and co-existence of both on LV longitudinal systolic performance, with particular focus on their potential interaction effect. Methods: The study population included 163 consecutive patients: 84 patients with hypertension, 36 with diabetes, and 43 who have both hypertension and diabetes; 70 healthy controls were also recruited. Systolic mitral annulus velocity (S m ) by Tissue Doppler and left atrioventricular plane displacement (AVPD) by M-mode were measured in all subjects.
The American Journal of Cardiology, 2009
Regional left ventricular (LV) myocardial functional changes in early diabetic cardiomyopathy have not been well documented. LV multidirectional strain and strain rate analyses by 2-dimensional speckle tracking were used to detect subtle myocardial dysfunction in 47 asymptomatic, male patients (age 57 ؎ 6 years) with type 2 diabetes mellitus. The results were compared to those from 53 male controls matched by age, body mass index, and body surface area. No differences were found in the LV end-diastolic volume index (40.7 ؎ 8.9 vs 44.1 ؎ 7.8 ml/m 2 , p ؍ NS), end-systolic volume index (16.0 ؎ 4.8 vs 17.8 ؎ 4.3 ml/m 2 , p ؍ NS), ejection fraction (61.0 ؎ 5.5% vs 59.8 ؎ 5.3%, p ؍ NS). The transmitral E/A (0.95 ؎ 0.21 vs 1.12 ؎ 0.32, p ؍ 0.007) and pulmonary S/D (1.45 ؎ 0.28 vs 1.25 ؎ 0.27, p ؍ 0.001) ratios were more impaired in the patients with diabetes mellitus. Importantly, the diabetic patients had impaired longitudinal, but preserved circumferential and radial systolic and diastolic, function. Diabetes mellitus was an independent predictor for longitudinal strain, systolic strain rate and early diastolic strain rate on multiple linear regression analysis (all p <0.001). In conclusion, the LV longitudinal systolic and diastolic function were impaired, but the circumferential and radial functions were preserved in patients with uncomplicated type 2 diabetes mellitus.
Changes in Diastolic Dysfunction in Diabetes Mellitus Over Time
The American Journal of Cardiology, 2009
Several studies have demonstrated evidence for preclinical left ventricular (LV) diastolic dysfunction in patients with diabetes mellitus (DM) independent of coronary disease or hypertension. The objective of our study was to determine if LV diastolic dysfunction determined by tissue Doppler indices worsens with duration of DM and to quantify the severity of dysfunction as a function of DM duration. From 1996 to 2007, all Olmsted County, MN residents with DM free of heart failure who had a subsequent measurement of diastolic function using tissue Doppler echocardiography were identified. We identified a validated group of 486 patients with incident diabetes mellitus with a subsequent tissue Doppler echocardiographic assessment of diastolic function. There was a significant association between the E/e' ratio and the time from diabetes diagnosis to echocardiogram using simple linear regression; for every 1 year after the onset of diabetes, the E/e' increased by 0.23 (95% CI=0.16-0.30; p=0.007) after adjustment for age, gender, body mass index, prior coronary disease, prior hypertension and ejection fraction. A duration of diabetes ≥ 4 years was independently associated with LV diastolic dysfunction (E/e'>15) in multivariable logistic regression modeling after adjustment for age, gender, body mass index, prior coronary disease, prior hypertension and ejection fraction (OR=1.91, 95% CI=1.19-3.07; p=0.007). There were 48 deaths in the validated cohort (6 cardiac deaths). In multivariable proportional hazard modeling, the E/e' ratio was predictive of all-cause mortality after adjustment for age, gender, coronary disease, hypertension, ejection fraction, left atrial volume and time from DM to echo (risk ratio= 1.11, 95% CI=1.03-1.20; p=0.005). In conclusion, a duration of DM of ≥ 4 years is correlated with significant LV diastolic dysfunction. LV diastolic dysfunction is predictive of all-cause mortality in patients with DM independent of hypertension and coronary disease.