Volume: 43 Issue: 1
Year: 2023, Page: 488-491, Doi: https://doi.org/10.51248/.v43i01.2378
Introduction and Aim: Diabetes mellitus (DM) is a significant risk factor for cardiovascular diseases (CVD) on its own resulting in left ventricular volume overload which may further impair left ventricular (LV) function. The aim of the study is to evaluate the diastolic dysfunction and global longitudinal strain (GLS) imaging in patients which helps to predict the cardiovascular mortality.
Materials and Methods: This study included 45 patients over 50 years with their evidence of fasting blood sugar and PPBS level. E/A, E/E’ and E’ are measured by TDI and Traditional 2D echocardiography; the following parameters are assessed: IVRT, IVCT, pulmonary venous flow and hepatic vein flow. GLS and strain rate were measured in AP4C, AP3C and AP2C views.
Results: In our study 93% of patients had normal GLS and 7% of patients had reduced GLS 16% of patients had normal diastolic dysfunction (DD), 68% had grade I DD and 16% of patients had grade II DD. DD does not correlate with GLS in diabetes mellitus patients.
Conclusion: According to current guidelines, patients with diabetes mellitus frequently have diastolic dysfunction, but it can also be caused by other reasons. It should be aimed to detect pre-diabetic patients with DD and optimize their clinical management which can be improved by utilizing tissue doppler imaging due to its potential to fill current need for a reliable tool that can demonstrate the effectiveness of therapy in future studies for preventing insulin resistance, DM, and cardiovascular disease
Keywords: Diabetes mellitus (DM); Global longitudinal strain (GLS); Diastolic dysfunction (DD); Left ventricle (LV).
1. Soedamah-Muthu, S. S., Fuller, J. H., Mulnier, H. E., Raleigh, V. S., Lawrenson, R.A., Colhoun, H.M. High risk of cardiovascular disease in patients with type 1 diabetes in the UK: a cohort study using the general practice research database. Diabetes Care 2006; 29(4): 798-804.
2. Lind, M., Bounias, I., Olsson, M., Gudbjörnsdottir, S., Svensson, A. M., Rosengren, A. Glycaemic control and incidence of heart failure in 20 985 patients with type 1
diabetes: an observational study. The Lancet. 2011; 378(9786):140-146.
3. Gorcsan, J., Tanaka, H. Echocardiographic assessment of myocardial strain. Journal of the American College of Cardiology. 2011; 58(14): 1401-1413.
4. Ersbøll, M., Valeur, N., Mogensen, U. M., Andersen, M. J., Møller, J. E., Velazquez, E. J., et al., Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction. Journal of the American College of Cardiology. 2013; 61(23): 2365-2373.
5. Cho, G. Y., Marwick, T. H., Kim, H. S., Kim, M. K., Hong, K. S., Oh, D.J. Global 2-dimensional strain as a new prognosticator in patients with heart failure. Journal of the American College of Cardiology. 2009; 54(7): 618-624.
6. Stanton, T., Leano, R., Marwick, T.H. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circulation: Cardiovascular Imaging. 2009; 2(5):356-364.
7. Diamant, M., Tushuizen, M. E. The metabolic syndrome and endothelial dysfunction: common highway to type 2 diabetes and CVD?. Current Diabetes Reports. 2006; 6(4): 279-286.
8. Reaven, G. M. Role of insulin resistance in human disease. Diabetes. 1988; 37(12): 1595-1607.
9. Shapiro, L. M., Leatherdale, B.A., Mackinnon, J., Fletcher, R.F. Left ventricular function in diabetes mellitus. II: Relation between clinical features and left ventricular function. Br Heart J. 1981; 45(2):129-132.
10. Kahn, J.K., Zola, B., Juni, J.E., Vinik, A.I. Radionuclide assessment of left ventricular diastolic filling in diabetes mellitus with and without cardiac autonomic neuropathy. J Am Coll Cardiol. 1986;7(6):1303-1309.
11. Labovitz, A.J., Pearson, A.C. Evaluation of left ventricular diastolic function: clinical relevance and recent Doppler echocardiographic insights. Am Heart J. 1987 Oct; 114(4 Pt 1):836-851.
12. Ferguson, J.J., Manning, W. J., Come, P.C. Pulsed Doppler echocardiographic determination of the time course of left ventricular filling: validation with cineangiography. Am Heart J. 1989;117(1):127-132.
13. Spirito, P., Maron, B.J. Doppler echocardiography for assessing left ventricular diastolic function. Ann Intern Med. 1988;109 (2):122-126
14. Orchard, T. J., Secrest, A. M., Miller, R. G., Costacou, T. In the absence of renal disease, 20 year mortality risk in type 1 diabetes is comparable to that of the general population: a report from the Pittsburgh epidemiology of diabetes complications study. Diabetologia. 2010; 53(11): 2312-2319.
15. Groop, P. H., Thomas, M. C., Moran, J. L., Waden, J., Thorn, L. M., Mäkinen, V. P., et al., The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes. Diabetes. 2009; 58(7): 1651-1658.
16. Fang, Z. Y., Prins, J. B., Marwick, T. H. Diabetic cardiomyopathy: evidence, mechanisms, and therapeutic implications. Endocrine Reviews. 2004; 25(4): 543-567.
17. Ernande, L., Rietzschel, E. R., Bergerot, C., De Buyzere, M. L., Schnell, F., et al., Impaired myocardial radial function in asymptomatic patients with type 2 diabetes mellitus: a speckle-tracking imaging study. Journal of the American Society of Echocardiography. 2010; 23(12): 1266-1272.
18. Risum, N., Ali, S., Olsen, N. T., Jons, C., Khouri, M. G., Lauridsen, T.K., et al., Variability of global left ventricular deformation analysis using vendor dependent and independent two-dimensional speckle-tracking software in adults. Journal of the American Society of Echocardiography. 2012; 25(11): 1195-1203.
19. Jørgensen, M.E., Almdal, T.P., Carstensen, B. Time trends in mortality rates in type 1 diabetes from. Diabetologia. 2013;56(11):2401-2404.
20. Pina, I.L., Balady, G.J., Hanson, P., Labovitz, A.J., Madonna,D.W., Myers, J. Guidelines for clinical exercise testing laboratories. A statement for healthcare professionals
from the Committee on Exercise and Cardiac Rehabilitation, American Heart Association. Circulation. 1995;91(3):912-921.
21. Takenaka, K., Sakamoto, T., Amano, K., Oku, J., Fujinami, K., Murakami, T., et al., Left ventricular filling determined by Doppler echocardiography in diabetes mellitus. Am J Cardiol. 1988;61(13):1140-1143.
22. Nishimura, R.A., Abel, M.D., Hatle, L.K., Tajik, A.J. Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part II. Clinical studies. Mayo Clin Proc. 1989; 64(2):181-204.
Abishkauf Jenish Beautlin, Ashok Govindaraj, Durgadevi, Uma Maheswari, Yamini. Correlation between diastolic dysfunction and global longitudinal strain imaging in patients with diabetes mellitus. Biomedicine: 2023; 43(1): 488-491