Early Detection of Left Ventricular Dysfunction in Diabetes Mellitus Patients with Normal Ejection Fraction,...

Diabetes mellitus (DM) represents by itself a major risk factor for cardiovascular events and the coexistence of obesity with consequent left ventricular volumetric overload could be responsible for further damages on left ventricular function. Aim of this study was to demonstrate the effect of body mass index (BMI) on left ventricular function in diabetes patients with no cardiovascular complications and with normal ejection fraction (EF).

We evaluated 71 stable asymptomatic diabetes patients in optimal medical treatment and 24 healthy controls (C) (45% females; mean age: 58.4 +/- 9.4 years; BMI: 23.5 +/- 1.5). We stratified diabetes patients into two groups according to BMI: BMI <30 kg/m² (A: 44 patients; 47% females; mean age: 60.9 +/- 6.6 years; BMI: 25.7 +/- 1.9; Diabetes duration: 9.1 +/- 9.5 years); BMI >30 kg/m² (B: 27 patients; 37% females; mean age: 56.2 +/- 7.8 years; BMI: 33.0 +/- 2.1; Diabetes duration: 8.5 +/- 5.2 years). The following parameters were evaluated by conventional two dimensional (2D) echocardiography (GE VIVID 7) and tissue Doppler imaging (TDI): left ventricular dimensions (LVIDd; PWTd; IVSd), Left Ventricular Volumes (EDV, ESV), EF (by biplane Simpson's method), Left Ventricular Mass (by ASE formula), peak mitral annular velocity at septal and lateral levels (Sm and Sl). Global longitudinal strain (GLS) was obtained off line by Speckle tracking imaging method using Echopac 10 software.

Groups A, B were comparable for diabetes duration and glycated hemoglobin level, history of hypertension, and lipid profile. The EF was similar in the three groups, (A: 64 +/- 6%; B: 63 +/- 4%; C: 61 +/-5%; P= NS). LVMass^2.7 indexed for height was significantly higher in A and B in comparison with C (A: 45.2 +/- 8.1 g/m^2.7; B: 46.1 +/- 9.6 g/m^2.7; C: 39.5 +/- 4.9 g/m^2.7; P < 0.05). The stroke volume index (SVi) was significantly lower in B vs A (B: 35.3 +/- 5.7 ml/m²; A: 39.3 +/7.1 ml/m²; P = 0.033). GLS was significantly lower in group B respect A and C (C: 20.9 +/- 1.3%; A: -20.3+/-2.6%; B: -19 +/- 2; P < 0.05; P < 0.01).

In uncomplicated asymptomatic DM patients, the presence of first degree obesity plays an incremental role in adversely affecting left ventricular function and remodeling. The conventional echocardiographic methods such as the EF and the TDI are not so sensitive to identify the early LV dysfunction such as the evaluation of GLS by Speckle Tracking echocardiography. The longitudinal subendocardial fibers dysfunction in diabetes/obese patients could be derived by the complex interaction between metabolic (diabetes) and hemodynamic/endocrine abnormalities.