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Li Z, Qian Y, Fan CY, Huang Y. Application of three-dimensional speckle tracking technique in measuring left ventricular myocardial function in patients with diabetes. World J Diabetes 2024; 15:783-792. [PMID: 38680686 PMCID: PMC11045408 DOI: 10.4239/wjd.v15.i4.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/28/2023] [Accepted: 03/07/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Diabetic cardiomyopathy is considered as a chronic complication of diabetes mellitus (DM). Therefore, early detection of left ventricular systolic function (LVSF) damage in DM is essential. AIM To explore the use of the three-dimensional speckle tracking technique (3D-STI) for measuring LVSF in DM patients via meta-analysis. METHODS The electronic databases were retrieved from the initial accessible time to 29 April 2023. The current study involved 9 studies, including 970 subjects. We carried out this meta-analysis to estimate myocardial function in DM compared with controls according to myocardial strain attained by 3D-STI. RESULTS Night articles including 970 subjects were included. No significant difference was detected in the left ventricular ejection fraction between the control and the diabetic group (P > 0.05), while differences in global longitudinal strain, global circumferential strain, global radial strain, and global area strain were markedly different between the controls and DM patients (all P < 0.05). CONCLUSION The 3D-STI could be applied to accurately measure early LVSF damage in patients with DM.
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Affiliation(s)
- Zheng Li
- Department of Ultrasound, The People’s Hospital of Danyang, Danyang Hospital of Nantong University, Danyang 212300, Jiangsu Province, China
| | - Ying Qian
- Department of Ultrasound, The People’s Hospital of Danyang, Danyang Hospital of Nantong University, Danyang 212300, Jiangsu Province, China
| | - Chun-Yun Fan
- Department of Ultrasound, The People’s Hospital of Danyang, Danyang Hospital of Nantong University, Danyang 212300, Jiangsu Province, China
| | - Yong Huang
- Department of Endocrinology, The People’s Hospital of Danyang, Danyang Hospital of Nantong University, Danyang 212300, Jiangsu Province, China
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Chen X, Shui X, Xu H, Peng J, Deng H, Zhong J, Wang C, Wu J, Yan J, Yao B, Xiong Z, Xu W, Yang X. Sudomotor dysfunction is associated with impaired left ventricular diastolic function in persons with type 2 diabetes: a cross-sectional study. J Endocrinol Invest 2024; 47:973-982. [PMID: 37999892 DOI: 10.1007/s40618-023-02214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/26/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The incidence of preserved ejection fraction heart failure has significantly increased in persons with type 2 diabetes mellitus (T2DM). Left ventricular (LV) diastolic dysfunction is an early and important manifestation of preserved ejection fraction heart failure. The onset of heart failure in persons with diabetes is associated with diabetic neuropathy. However, the relationship among sudomotor function, which is an early manifestation of small fiber neuropathy, and LV diastolic function remains unclear. This study aimed to explore the association between sudomotor function and LV diastolic function in persons with T2DM. METHODS In total, 699 persons with T2DM were enrolled and divided into three groups according to electrochemical skin conductance (ESC) assessed using the SUDOSCAN device: "no dysfunction" group (NSF), "moderate dysfunction" group (MDF), and "severe dysfunction" group (SDF). LV diastolic function was assessed using Doppler echocardiography. To evaluate the relationship between ESC and echocardiographic parameters, Pearson's correlation analysis was performed. Additionally, logistic regression analysis was used to determine the association between LV diastolic function and ESC. A receiver operating characteristic (ROC) curve was constructed to evaluate the performance of sudomotor function indicators in detecting impaired cardiac diastolic function. RESULTS There were 301 persons (43.06%) in the NSF group, 232 (33.19%) in the MDF group, and 166 (23.75%) in the SDF group. Compared to the NSF group, the MDF and SDF groups had higher A and E/e' and lower e' values (all p < 0.05). Pearson's correlation analysis showed that A and E/e' were negatively associated with foot ESC (FESC) and hand ESC (HESC), whereas e' was positively associated with FESC and HESC (all p < 0.05). After adjusting for confounding factors, binary logistic regression analysis showed that ESC was independently associated with impaired LV diastolic function (p = 0.003). The area under the ROC curve values for FESC and HESC were 0.621 and 0.635, respectively (both p < 0.05). CONCLUSIONS Deteriorating sudomotor function was associated with reduced diastolic function indicators. ESC can be used as a biomarker for detecting LV diastolic impairment.
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Affiliation(s)
- X Chen
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - X Shui
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - H Xu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - J Peng
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - H Deng
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - J Zhong
- Department of Ultrasonography, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - C Wang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - J Wu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - J Yan
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - B Yao
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - Z Xiong
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China.
| | - W Xu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China.
| | - X Yang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China.
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Nickander J, Wieslander B. Editorial for "Glycemic Status and Myocardial Strain by Cardiac MRI in Patients With ST-Segment Elevation Myocardial Infarction". J Magn Reson Imaging 2024; 59:561-562. [PMID: 37255403 DOI: 10.1002/jmri.28796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
Level of Evidence5Technical EfficacyStage 5
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Affiliation(s)
- Jannike Nickander
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Björn Wieslander
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Guo Y, Guo Q, Guo R, Yan Y, Gong W, Zheng W, Wang H, Xu L, Wang X, Nie S. Glycemic Status and Myocardial Strain by Cardiac MRI in Patients With ST-Segment Elevation Myocardial Infarction. J Magn Reson Imaging 2024; 59:548-560. [PMID: 37222658 DOI: 10.1002/jmri.28794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND It is uncertain how various degree of glycemic status affect left ventricular (LV) myocardial strain in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). PURPOSE To investigate the relationship of glycemic status and myocardial strain in STEMI patients. STUDY TYPE Prospective cohort study. POPULATION 282 STEMI patients with cardiac magnetic resonance imaging 5 ± 2 days post-PPCI. Patients were divided into three groups based on the level of glycated hemoglobin A1c (HbA1c) (group 1: HbA1c < 5.7%; group 2: 5.7% ≤ HbA1c < 6.5%; group 3: HbA1c ≥ 6.5%). FIELD STRENGTH/SEQUENCE 3.0-T; late gadolinium enhancement, balanced steady-state free precession cine sequence, black blood fat-suppressed T2-weighted. ASSESSMENT LV function, myocardial strain, and infarct characteristics (infarct size, microvascular obstruction, and intramyocardial hemorrhage) were compared among the three groups by one-way analysis of variance (ANOVA) or Wilcoxon rank sum test. Intraobserver and interobserver reproducibility of LV myocardial strain was evaluated. STATISTICAL TESTS ANOVA or Wilcoxon rank sum test, Pearson chi-square or Fisher's exact test, Spearman's correlation analyses and multivariable linear regression analysis. A two-tailed P value <0.05 was considered statistically significant. RESULTS Infarct characteristics were similar among the three groups (P = 0.934, P = 0.097, P = 0.533, respectively). Patients with HbA1c ≥ 6.5% had decreased LV myocardial strain compared with HbA1c 5.7%-6.4%, as evidenced by global radial (GRS), global circumferential (GCS), and global longitudinal (GLS) strain. However, no significant differences in myocardial strain were observed between patients with HbA1c 5.7%-6.4% and HbA1c < 5.7% (P = 0.716; P = 0.294; P = 0.883, respectively). After adjustment for confounders, HbA1c as a continuous variable (beta coefficient [β] = -0.676; β = 0.172; β = 0.205, respectively) and HbA1c ≥ 6.5% (β = -3.682; β = 0.552; β = 0.681, respectively) were both independently associated with decreased GRS, GCS, and GLS. DATA CONCLUSION Patients with uncontrolled blood glucose (categorized in group HbA1c ≥ 6.5%) had worse myocardial strain. The level of HbA1c appeared to be independently associated with decreased myocardial strain in STEMI patients. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Yingying Guo
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qian Guo
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruifeng Guo
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Yan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Gong
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wen Zheng
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Gao J, Xu M, Gong M, Jiang S, Yang Z, Jiang X, Chen M. Left ventricular longitudinal strain in patients with type 2 diabetes mellitus is independently associated with glycated hemoglobin level. Clin Cardiol 2023; 46:1578-1587. [PMID: 37621117 PMCID: PMC10716340 DOI: 10.1002/clc.24136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE Left ventricular and left atrial strain are sensitive and reliable markers for evaluating cardiac function in patients with type 2 diabetes mellitus (T2DM), with interactions between the two parameters. The present study aimed to analyze the correlation between global longitudinal strain (GLS) of the left ventricle and glycated hemoglobin (HbA1c) levels in patients with T2DM. METHODS A total of 292 patients clinically diagnosed with T2DM were selected and divided into three groups according to HbA1c level. The strains of the left atrium and left ventricle in the three groups of T2DM patients with different HbA1c levels were compared. Univariate and multivariate (including left atrial functional indicators) linear regression analyses were performed to assess the relationship between strain indicators and HbA1c levels. Generalized additive models were used to examine the relationship between strain indicators and HbA1c levels. RESULTS There were significant differences among the three groups in terms of age, microalbuminuria, total cholesterol, fasting blood glucose, postprandial blood glucose, and HbA1c level, and left atrial conduit longitudinal strain (LAScd) and GLS (p < .05). Univariate and multivariate linear regression analyses revealed that, as HbA1c levels increased, the absolute value of GLS gradually decreased (p < .001). Curve fitting revealed a positive correlation between HbA1c level and GLS, which was not affected by left atrial function. CONCLUSION Left ventricular GLS was independently correlated with HbA1c level in patients with T2DM and was not affected by left atrial function.
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Affiliation(s)
- Jinmei Gao
- Department of Echocardiography and CardiologyThe Third Affiliated Hospital of Soochow UniversityChang ZhouChina
| | - Min Xu
- Department of Echocardiography and CardiologyThe Third Affiliated Hospital of Soochow UniversityChang ZhouChina
| | - Mingxia Gong
- Department of Echocardiography and CardiologyThe Third Affiliated Hospital of Soochow UniversityChang ZhouChina
| | - Shu Jiang
- Department of Echocardiography and CardiologyThe Third Affiliated Hospital of Soochow UniversityChang ZhouChina
| | - Zhenni Yang
- Department of Echocardiography and CardiologyThe Third Affiliated Hospital of Soochow UniversityChang ZhouChina
| | - Xiaohong Jiang
- Department of EndocrinologyThe Third Affiliated Hospital of Soochow UniversityChang ZhouChina
| | - Ming Chen
- Department of Medical ImagingThe Third Affiliated Hospital of Soochow UniversityChang ZhouChina
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Obert P, Nottin S, Philouze C, Aboukhoudir F. Major impact of vitamin D 3 deficiency and supplementation on left ventricular torsional mechanics during dobutamine stress in uncomplicated type 2 diabetes. Nutr Metab Cardiovasc Dis 2023; 33:2269-2279. [PMID: 37543521 DOI: 10.1016/j.numecd.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/09/2023] [Accepted: 06/21/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND AND AIMS Hypovitaminosis D is associated with the risk of diabetic complications. Its role in diabetic-related cardiac abnormalities remain poorly understood. We aimed therefore to evaluate the effect of vitamin D deficiency and supplementation on early left ventricular (LV) dysfunction in vitamin D deficient patients with uncomplicated T2D. METHODS AND RESULTS Sixty-three consecutive T2D patients who had a diagnosis of vitamin D3 were prospectively recruited and allocated into 2 groups (25(OH)D < 20 ng/mL: VDD, >20 ng/mL VDND). Twenty-eight of them with 25(OH)D < 20 ng/mL benefited from a 3-month supplementation. At baseline and follow-up, after conventional echocardiography including evaluation of epicardial adipose tissue (EAT), both LV longitudinal (LS) and circumferential (CS) strains and rotation/twist mechanics were evaluated at rest and during dobutamine (DOB) stress. After treatment, T2D patients successfully normalized their 25(OH)D levels. The strongest associations between vitamin D deficiency and supplementation with LV myocardial function were noticed for torsional mechanics indexes under DOB. EAT correlated significantly (p < 0.01) with baseline 25(OH)D and was reduced after supplementation. Significant correlations were obtained between these 2 parameters with twist or apical rotation at baseline (p < 0.01) and between their delta changes at follow-up (p < 0.01) under DOB. Significant improvements in LS and CS (p < 0.05) under DOB were also underlined at follow-up, with major enhancements noticed in the apical region (p < 0.01) of the LV. CONCLUSIONS This study provides the first evidences of the potential of vitamin D supplementation as an efficient prophylactic strategy to alleviate the progression of myocardial dysfunction in asymptomatic patients with uncomplicated T2D. CLINICALTRIALS NCT03437421.
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Affiliation(s)
- Philippe Obert
- UPR(4278) LaPEC, Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France.
| | - Stéphane Nottin
- UPR(4278) LaPEC, Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France
| | - Clothilde Philouze
- UPR(4278) LaPEC, Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France
| | - Falah Aboukhoudir
- UPR(4278) LaPEC, Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France; Cardiology department, Duffaut Hospital Center, Avignon, France.
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7
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Jiang L, Liu J, Yang Z, Zhang C, Wang J, Ke W, Zuo H, Wang L. The effect of type 2 diabetes mellitus on multiple obstructive coronary artery disease. Echocardiography 2023; 40:235-243. [PMID: 36789679 DOI: 10.1111/echo.15539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/22/2022] [Accepted: 11/30/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Although type 2 diabetes mellitus (T2DM) individuals easily develop three-vessel disease (3VD) coronary artery disease (CAD), there is very little information available about their left ventricle (LV) functions. The purpose of this study is to evaluate the LV function using two-dimensional speckle tracking echocardiography (2-D STE) in T2DM patients with 3VD. METHODS One hundred and three consecutive patients with confirmed 3VD CAD were enrolled and divided into two groups, while 53 patients with DM and 50 patients without. The control group was composed of 30 age- and sex-matched healthy individuals. All patients underwent 2-D STE and standard echocardiograms. The durations of DM and the level of HbA1c were also recorded. RESULT Between the 3VD-DM and 3VD-non-DM groups, normal echocardiography did not reveal any appreciable differences. However, patients with 3VD-DM had significantly lower global longitudinal strain (GLS) than those with 3VD-non-DM (15.87 ± 2.51 vs.17.56 ± 2.72, p < .05) by 2-D STE strain measurement. Besides, patients whose duration of DM excess 5 years showed significant lower GLS than those with less than 5 years duration (14.25 ± 2.31 vs. 16.65 ± 1.96, p = .007). However, there was no difference in GLS between the 3VD-DM patients with HbA1c ≥ 7% and HbA1c < 7%. CONCLUSIONS Compared to patients with 3VD alone, those with 3VD-DM have a lower cardiac function. In 3VD-DM patients, the duration of DM is a significant factor that contributes to cardiac function deterioration, whereas, the glucose control state has limited influence.
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Affiliation(s)
- Luying Jiang
- The 3rd Department of Cardiology, The First Affiliated Hospital of The Medical College, Shihezi University, Shihezi, Xinjiang, China.,Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, Hubei Province, China.,NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Disease, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Jingbo Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, Hubei Province, China
| | - Zhenjia Yang
- The 3rd Department of Cardiology, The First Affiliated Hospital of The Medical College, Shihezi University, Shihezi, Xinjiang, China.,Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Disease, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Chunran Zhang
- The 3rd Department of Cardiology, The First Affiliated Hospital of The Medical College, Shihezi University, Shihezi, Xinjiang, China.,Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Disease, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Jianyu Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, Hubei Province, China.,Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, Hubei Province, China
| | - Wenkai Ke
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, Hubei Province, China.,Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, Hubei Province, China
| | - Houjuan Zuo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, Hubei Province, China
| | - Li Wang
- The 3rd Department of Cardiology, The First Affiliated Hospital of The Medical College, Shihezi University, Shihezi, Xinjiang, China.,NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Disease, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
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Prestegui-Muñóz DE, Benítez-Maldonado DR, Rodríguez-Álvarez K, de Jesús Prestegui-Muñoz JÁ, Melchor-López A, Suárez-Cuenca JA. Epicardial adipose tissue thickness is related to early subclinical myocardial dysfunction, particularly in patients with type 2 diabetes mellitus: a case control study. BMC Cardiovasc Disord 2022; 22:514. [PMID: 36460985 PMCID: PMC9717527 DOI: 10.1186/s12872-022-02944-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cardiac myofibrillary dysfunction, which can be measure by echocardiographical strain value, represents an early subclinical manifestation of heart failure. Epicardial Adipose tissue (EAT) is related to low degree inflammation and oxidative damage in the adjacent tissue. AIM To explore whether EAT affects early myocardial dysfunction, as assessed strain values. METHODS Case-Control design. Patients lacking clinical significant heart failure, thyroid or renal disease or malignant abnormalities were included. Clinical-demographic and biochemical data were collected. EAT and myofibril deformation were measured by echocardiography. RESULTS A total of 71 patients were analyzed, and further subdivided according to type 2 Diabetes Mellitus (t2DM). Higher strain value (higher than -22.4%cut-off value) was associated with male sex and higher anthropometric and metabolic risk measures; particularly those with t2DM. Higher EAT was also associated higher strain value (AUC = 0.92 ± 0.06, p = 0.004), and further correlation was evidenced (rho = 0.488, p < 0.001), with significant influence of t2DM. CONCLUSION EAT was related to strain value, suggesting the influence of cardiac adipose tissue on the deformability of cardiac myofibril, with a more significant effect in the population with t2DM.
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Affiliation(s)
- David Eduardo Prestegui-Muñóz
- grid.415745.60000 0004 1791 0836Hospital General de Ticomán, Secretaría de Salud Ciudad de México, Mexico City, Mexico
| | | | - Karen Rodríguez-Álvarez
- grid.415745.60000 0004 1791 0836Hospital General de Ticomán, Secretaría de Salud Ciudad de México, Mexico City, Mexico
| | | | - Alberto Melchor-López
- grid.415745.60000 0004 1791 0836Hospital General Xoco, Secretaría de Salud Ciudad de México, Mexico City, Mexico
| | - Juan Antonio Suárez-Cuenca
- grid.415745.60000 0004 1791 0836Hospital General Xoco, Secretaría de Salud Ciudad de México, Mexico City, Mexico
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Aboukhoudir F, Philouze C, Grandperrin A, Nottin S, Obert P. Additive effects of type 2 diabetes and metabolic syndrome on left ventricular torsion and linear deformation abnormalities during dobutamine stress echocardiography. Front Cardiovasc Med 2022; 9:991415. [PMID: 36158831 PMCID: PMC9492989 DOI: 10.3389/fcvm.2022.991415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The interplay between metabolic syndrome (MS) and type 2 diabetes (T2D) on regional myocardial mechanics and the potential additional effects of their combination remain poorly understood. In this context, we evaluated left ventricular (LV) torsion and linear deformation at rest and under dobutamine (DB) stress in patients with T2D, MS or both. Methods Thirty-nine T2D patients without MS (T2D), 37 MS patients free from T2D (MS), 44 patients with both T2D and MS (T2D-MS group) and 38 healthy patients (control group) were prospectively recruited. Speckle-tracking echocardiography (STE) was conducted at rest and low dose DB to evaluate LV myocardial longitudinal (LS) as well as circumferential (CS) strain and early diastolic strain rate (LSrd, CSrd) and twist-untwist mechanics. Results At rest, MS, T2D and controls presented with similar resting LS and LSrd while significant lower values were obtained in T2D-MS compared to controls. DB revealed reduced LS, LSrd, CS and CSrd in MS and T2D groups compared to controls. In T2-MS, the decline in LS and LSrd established at rest was exacerbated under DB. Stress echocardiography revealed also lower basal rotation and subsequently lower twist in MS and T2D patients compared to controls. T2D-MS showed major impairments of apical rotation and twist under DB stress, with values significantly lower compared to the 3 other groups. From stepwise multiple linear regression analysis, epicardial adipose tissue for Δ (rest to DB) LS, numbers of MS factors for Δ CS and Δ Twist emerged as major independent predictors. Conclusion These results demonstrate synergic and additive effects of T2D and MS on LV torsion and linear deformation abnormalities in asymptomatic patients with metabolic diseases. They also highlight the usefulness of speckle tracking echocardiography under DB stress in detecting multidirectional myocardial mechanics impairments that can remain barely detectable at rest, such as in isolated T2D or MS patients.
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Affiliation(s)
- Falah Aboukhoudir
- UPR4278 LaPEC, Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France
- Cardiology Department, Duffaut Hospital Center, Avignon, France
| | - Clothilde Philouze
- UPR4278 LaPEC, Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France
| | - Antoine Grandperrin
- UPR4278 LaPEC, Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France
| | - Stéphane Nottin
- UPR4278 LaPEC, Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France
| | - Philippe Obert
- UPR4278 LaPEC, Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France
- *Correspondence: Philippe Obert,
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Song XT, Zhang PY, Fan L, Rui YF. Epicardial adipose tissue and right ventricular function in type 2 diabetes mellitus using two-dimensional speckle tracking echocardiography. Diab Vasc Dis Res 2022; 19:14791641221118622. [PMID: 35999047 PMCID: PMC9421037 DOI: 10.1177/14791641221118622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Epicardial adipose tissue is an emerging cardiovascular risk factor. The aim of this study was to evaluate right ventricular function and investigate its association with EAT in T2DM patients. METHODS 154 T2DM patients were divided into two groups according to EAT thickness: T2DM with EAT <5 mm and T2DM with EAT ≥5 mm. Seventy non-T2DM patients were enrolled as control group. RV function was evaluated using both conventional echocardiography as well as two-dimensional speckle tracking echocardiography. EAT thickness was measured as the echo-free space between the free wall of the right ventricle and the visceral layer of pericardium at end-systole. RESULTS Compared to control group, EAT thickness was significantly higher and RV systolic function and early diastolic function are all impaired in all T2DM patients. In T2DM with EAT ≥5 mm group, RV systolic function and early diastolic function suffered more severe impairment when compared with T2DM with EAT <5 mm group. Multivariate linear regression analysis revealed that EAT was associated with RV systolic and early diastolic dysfunction independent of traditional cardiovascular risk factors. CONCLUSIONS Our research suggest that in T2DM patients RV systolic function and early diastolic function are all impaired which are associated with the thickened EAT.
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Affiliation(s)
- Xiang-ting Song
- Department of Echocardiography, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
- Xiang-ting Song, Department of Echocardiography, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, No. 29, Xinglong Lane, Tianning District, Changzhou 213003, China.
| | - Ping-yang Zhang
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Li Fan
- Department of Echocardiography, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
| | - Yi-fei Rui
- Department of Echocardiography, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
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11
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Zhang X, You Y, Wang L, Ai C, Huang L, Wang S, Wang Z, Song S, Zhu B. Anti-obesity effects of Laminaria japonica fucoidan in high-fat diet-fed mice vary with the gut microbiota structure. Food Funct 2022; 13:6259-6270. [PMID: 35593392 DOI: 10.1039/d2fo00480a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Previous studies have indicated that fucoidan could resist high-fat-diet (HFD)-induced obesity by modulating the composition of gut microbiota. However, the outcome of dietary intervention may differ between individuals due to large inter-individual variability in gut microbiota. Thus, the present study aimed to investigate the possible discrepancy of the anti-obesity effects of fucoidan supplementation in HFD-fed mice models with different gut microbiota communities. In the present study, the anti-obesity effects of fucoidan isolated from Laminaria japonica (FucLj) on normal mice and microbiota-altered mice treated with penicillin or metronidazole were compared and investigated. The 16S rRNA sequencing revealed the differences of gut microbiota among penicillin-treated, metronidazole-treated and normal groups, and mice treated with penicillin were characterized by greater relative abundance of the phylum Bacteroidetes and the families Muribaculaceae and Bacteroidaceae. Furthermore, FucLj ameliorated HFD-induced body weight gain, fat accumulation, serum lipid profiles, insulin resistance, hepatic steatosis and adipocyte hypertrophy in penicillin-treated and untreated mice, while no effects were observed in metronidazole-treated mice. Overall, mice with different initial gut microbiota responded differently to FucLj supplementation on a high-fat diet, and metronidazole-sensitive gut bacteria negatively correlated with obesity symptoms and were required for the anti-obesity effects of FucLj. Moreover, the anti-obesity effects were not dependent on the utilization of FucLj by gut microbiota to produce SCFAs. These findings indicate that evaluation of the gut microbiota structure before dietary interventions is helpful for enhancing the beneficial outcomes of dietary fiber supplementation and provide a rationale for the further application of dietary fucoidan in a personalized way.
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Affiliation(s)
- Xueqian Zhang
- National Engineering Research Center of Seafood, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China.
- College of Food Science and Technology, Northwest University, Xi'an 710069, China.
| | - Ying You
- National Engineering Research Center of Seafood, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China.
| | - LiLong Wang
- National Engineering Research Center of Seafood, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China.
| | - Chunqing Ai
- National Engineering Research Center of Seafood, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China.
- National & Local Joint Engineering Laboratory for Marine Bioactive Polysaccharide Development and Application, Dalian Polytechnic University, Dalian 116034, China
| | - Linjuan Huang
- College of Food Science and Technology, Northwest University, Xi'an 710069, China.
- Shaanxi Natural Carbohydrate Resource Engineering Research Center, College of Food Science and Technology, Northwest University, Xi'an 710069, China
| | - Songtao Wang
- National Engineering Research Center of Solid-State Brewing, Luzhou Pinchuang Technology Company Limited, Luzhou, 646000, China
| | - Zhongfu Wang
- College of Food Science and Technology, Northwest University, Xi'an 710069, China.
- Shaanxi Natural Carbohydrate Resource Engineering Research Center, College of Food Science and Technology, Northwest University, Xi'an 710069, China
| | - Shuang Song
- National Engineering Research Center of Seafood, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China.
- National & Local Joint Engineering Laboratory for Marine Bioactive Polysaccharide Development and Application, Dalian Polytechnic University, Dalian 116034, China
| | - Beiwei Zhu
- National Engineering Research Center of Seafood, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China.
- National & Local Joint Engineering Laboratory for Marine Bioactive Polysaccharide Development and Application, Dalian Polytechnic University, Dalian 116034, China
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12
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Song XT, Wang SK, Zhang PY, Fan L, Rui YF. Association between epicardial adipose tissue and left ventricular function in type 2 diabetes mellitus: Assessment using two-dimensional speckle tracking echocardiography. J Diabetes Complications 2022; 36:108167. [PMID: 35272930 DOI: 10.1016/j.jdiacomp.2022.108167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/20/2022] [Accepted: 03/02/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Epicardial adipose tissue (EAT) is the visceral fat between the myocardium and the visceral pericardium. Dysfunctional EAT can cause cardiovascular diseases. The aim of this study was to investigate the association between EAT and left ventricular function in type 2 diabetes mellitus (T2DM) patients by two-dimensional speckle tracking echocardiography (2D-STE). METHODS We prospectively enrolled 116 T2DM patients who were divided into two groups according to their left ventricular global longitudinal strain (GLS): 53 with GLS <18% and 63 with GLS ≥18%. The thickness of EAT was measured as the echo-free space between the free wall of the right ventricle and the visceral layer of pericardium at end-systole. LV systolic function was evaluated by GLS measured by 2D-STE. LV diastolic function was defined as the ratio of the early diastolic transmitral flow velocity (E) to average mitral annular velocity (e¯). RESULTS Compared with patients with GLS ≥18% group, the age, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), glycosylated hemoglobinA1c (HbA1c), E/e¯, and thickness of EAT were higher in patients with GLS <18% group (all P < 0.05). Multivariate linear regression analysis revealed that the thickness of EAT was independently associated with left ventricular GLS and E/e¯. CONCLUSIONS Thickened EAT is associated with impaired left ventricular function in T2DM patients. To investigate the association between EAT and left ventricular function can help us gain a deeper understanding of the pathogenesis of impaired cardiac function in T2DM patients.
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Affiliation(s)
- Xiang-Ting Song
- Department of Laboratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China; Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China; Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Shu-Kui Wang
- Department of Laboratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.
| | - Ping-Yang Zhang
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.
| | - Li Fan
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Yi-Fei Rui
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
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13
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Marwick TH, Gimelli A, Plein S, Bax JJ, Charron P, Delgado V, Donal E, Lancellotti P, Levelt E, Maurovich-Horvat P, Neubauer S, Pontone G, Saraste A, Cosyns B, Edvardsen T, Popescu BA, Galderisi M, Derumeaux G, Bäck M, Bertrand PB, Dweck M, Keenan N, Magne J, Neglia D, Stankovic I. Multimodality imaging approach to left ventricular dysfunction in diabetes: an expert consensus document from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2022; 23:e62-e84. [PMID: 34739054 DOI: 10.1093/ehjci/jeab220] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/14/2023] Open
Abstract
Heart failure (HF) is among the most important and frequent complications of diabetes mellitus (DM). The detection of subclinical dysfunction is a marker of HF risk and presents a potential target for reducing incident HF in DM. Left ventricular (LV) dysfunction secondary to DM is heterogeneous, with phenotypes including predominantly systolic, predominantly diastolic, and mixed dysfunction. Indeed, the pathogenesis of HF in this setting is heterogeneous. Effective management of this problem will require detailed phenotyping of the contributions of fibrosis, microcirculatory disturbance, abnormal metabolism, and sympathetic innervation, among other mechanisms. For this reason, an imaging strategy for the detection of HF risk needs to not only detect subclinical LV dysfunction (LVD) but also characterize its pathogenesis. At present, it is possible to identify individuals with DM at increased risk HF, and there is evidence that cardioprotection may be of benefit. However, there is insufficient justification for HF screening, because we need stronger evidence of the links between the detection of LVD, treatment, and improved outcome. This review discusses the options for screening for LVD, the potential means of identifying the underlying mechanisms, and the pathways to treatment.
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Affiliation(s)
- Thomas H Marwick
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Center & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Phillippe Charron
- Sorbonne Université, INSERM UMRS 1166 and ICAN Institute, Paris, France
- APHP, Centre de référence pour les maladies cardiaques héréditaires ou rares, Hôpital Pitié-Salpêtrière, Paris, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2300RC, The Netherlands
| | - Erwan Donal
- Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000 Rennes, France
- Université de Rennes 1, LTSI, 35000 Rennes, France
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU SartTilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Eylem Levelt
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital , Groby Road, Leicester LE3 9QF, UK
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, 2 Koranyi u., 1083 Budapest, Hungary
| | - Stefan Neubauer
- Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Headley Way, Oxford OX3 9DU, UK
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, University of Milan, Cardiovascular Imaging, Milan, Italy
| | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland
- Heart Center, Turku University Hospital, Turku, Finland
| | - Bernard Cosyns
- Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, 109 Laarbeeklaan, Brussels 1090, Belgium
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Postbox 4950 Nydalen, Sognsvannsveien 20, NO-0424 Oslo, Norway
- Institute for clinical medicine, University of Oslo, Sognsvannsveien 20, NO-0424 Oslo, Norway
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Genevieve Derumeaux
- IMRB - Inserm U955 Senescence, metabolism and cardiovascular diseases 8, rue du Général Sarrail, 94010 Créteil, France
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Huang D, Cui C, Zheng Q, Li Y, Liu Y, Hu Y, Wang Y, Liu R, Liu L. Quantitative Analysis of Myocardial Work by Non-invasive Left Ventricular Pressure-Strain Loop in Patients With Type 2 Diabetes Mellitus. Front Cardiovasc Med 2021; 8:733339. [PMID: 34660736 PMCID: PMC8517392 DOI: 10.3389/fcvm.2021.733339] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) is a common risk factor for cardiovascular diseases. The aims of this study were to evaluate the changes in the left ventricular myocardial work in T2DM patients using the left ventricular pressure-strain loop (PSL) technique, and to explore the risk factors for the left ventricular myocardial work impairment. Methods: Fifty patients with T2DM and 50 normal controls (NCs) were included in the study. In addition to conventional echocardiography and two-dimensional speckle tracking echocardiography, the left ventricular myocardial work parameters were measured using PSL technology. Results: The absolute value for global longitudinal strain (GLS), global work index (GWI) and, global constructive work (GCW) were significantly decreased in the T2DM group (P < 0.05), while the left ventricular ejection fraction (LVEF) was not significantly different between the T2DM and NC groups. Multivariable linear regression analysis showed that hemoglobin A1c (HbA1c) was independently related to GWI (β = −0.452, P < 0.05), while HbA1c and the diabetes duration were independently related to GCW (β = −0.393, P < 0.05 and β = −0.298, P < 0.05, respectively). Conclusions: Changes in the left ventricular myocardial systolic function in T2DM patients were identified using PSL technology. HbA1c was shown to be an independent risk factor affecting GWI, while HbA1c and diabetes duration were demonstrated to be independent risk factors affecting GCW.
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Affiliation(s)
- Danqing Huang
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Cunying Cui
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Zheng
- School of Computer and Control Engineering, Yantai University, Yantai, China
| | - Yanan Li
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanyuan Liu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanbin Hu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Wang
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruijie Liu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Liu
- Department of Ultrasound, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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15
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Ghoreyshi-Hefzabad SM, Jeyaprakash P, Gupta A, Vo HQ, Pathan F, Negishi K. Three-Dimensional Global Left Ventricular Myocardial Strain Reduced in All Directions in Subclinical Diabetic Cardiomyopathy: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e020811. [PMID: 34585594 PMCID: PMC8649137 DOI: 10.1161/jaha.121.020811] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Three‐dimensional (3D) speckle tracking echocardiography can identify subclinical diabetic cardiomyopathy without geometric assumption and loss of speckle from out‐of‐plane motions. There is, however, significant heterogeneity among the previous reports. We performed a systematic review and meta‐analysis to compare 3D strain values between adults with asymptomatic, subclinical diabetes mellitus (ie, patients with diabetes mellitus without known clinical manifestations of cardiac disease) and healthy controls. Methods and Results After systematic review of 5 databases, 12 valid studies (544 patients with diabetes mellitus and 489 controls) were eligible for meta‐analysis. Pooled means and mean difference (MD) using a random‐effects model for 3D global longitudinal, circumferential, radial, and area strain were calculated. Patients with diabetes mellitus had an overall 2.31 percentage points lower 3D global longitudinal strain than healthy subjects (16.6%, 95% CI, 15.7–17.6 versus 19.0; 95% CI, 18.2–19.7; MD, −2.31, 95% CI, −2.72 to −2.03). Similarly, 3D global circumferential strain (18.9%; 95% CI, 17.5–20.3 versus 20.5; 95% CI, 18.9–22.1; MD, −1.50; 95% CI, −2.09 to −0.91); 3D global radial strain (44.6%; 95% CI, 40.2–49.1 versus 48.2; 95% CI, 44.7–51.8; MD, −3.47; 95% CI, −4.98 to −1.97), and 3D global area strain (30.5%; 95% CI, 29.2–31.8 versus 32.4; 95% CI, 30.5–34.3; MD, −1.76; 95% CI, −2.74 to −0.78) were also lower in patients with diabetes mellitus. Significant heterogeneity was noted between studies for all strain directions (inconsistency factor [I2], 37%–78%). Meta‐regression in subgroup analysis of studies using the most popular vendor found higher prevalence of hypertension as a significant contributor to worse 3D global longitudinal strain. Higher hemoglobulin A1c was the most significant contributor to worse 3D global circumferential strain in patients with diabetes mellitus. Conclusions Three‐dimensional myocardial strain was reduced in all directions in asymptomatic diabetic patients. Hypertension and hemoglobin A1c were associated with worse 3D global longitudinal strain and 3D global circumferential strain, respectively. Registration URL: https://www.crd.york.ac.uk/prospero; unique identifier: CRD42020197825.
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Affiliation(s)
- Seyed-Mohammad Ghoreyshi-Hefzabad
- Faculty of Medicine and Health Charles Perkins Centre Nepean Sydney Medical School NepeanThe University of Sydney Kingswood Australia
| | - Prajith Jeyaprakash
- Faculty of Medicine and Health Charles Perkins Centre Nepean Sydney Medical School NepeanThe University of Sydney Kingswood Australia.,Department of Cardiology Nepean Hospital Kingswood Australia
| | - Alpa Gupta
- Faculty of Medicine and Health Charles Perkins Centre Nepean Sydney Medical School NepeanThe University of Sydney Kingswood Australia
| | - Ha Q Vo
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Faraz Pathan
- Faculty of Medicine and Health Charles Perkins Centre Nepean Sydney Medical School NepeanThe University of Sydney Kingswood Australia.,Department of Cardiology Nepean Hospital Kingswood Australia
| | - Kazuaki Negishi
- Faculty of Medicine and Health Charles Perkins Centre Nepean Sydney Medical School NepeanThe University of Sydney Kingswood Australia.,Department of Cardiology Nepean Hospital Kingswood Australia.,Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
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16
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Song XT, Fan L, Yan ZN, Rui YF. Echocardiographic evaluation of the effect of poor blood glucose control on left ventricular function and ascending aorta elasticity. J Diabetes Complications 2021; 35:107943. [PMID: 33934972 DOI: 10.1016/j.jdiacomp.2021.107943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Type 2 diabetes mellitus (T2DM) is associated with high cardiovascular risk. Preclinical left ventricular (LV) dysfunction and subclinical arterial stiffness have been documented in patients with T2DM. The aims of this study were to investigate whether there were any differences in LV function and ascending aorta elasticity between T2DM patients with controlled [defined as glycosylated hemoglobin (HbA1c) <6.5%] and uncontrolled (HbA1c ≥6.5%) blood glucose. METHODS We studied 86 T2DM patients: 42 T2DM patients with controlled blood glucose (controlled T2DM group) and 44 T2DM patients with uncontrolled blood glucose (uncontrolled T2DM group), and 40 healthy subjects as control. They all underwent transthoracic echocardiography examination, LV systolic function was evaluated by global longitudinal strain (GLS) and LV diastolic function was defined as the ratio of the early diastolic transmitral flow velocity (E) to average mitral annular velocity (e¯). Ascending aorta inner diameters and brachial blood pressure were measured to calculate ascending aorta elastic parameters: compliance (C), distensibility (D), strain (S), stiffness index (SI), Peterson's elastic modulus (EM). RESULTS Compared to control, T2DM patients had reduced GLS, increased E/e ̅ and impaired ascending aorta elasticity. Furthermore, LV function and ascending aorta elasticity were more severely damaged in uncontrolled T2DM group compared with controlled T2DM group. By Pearson correlation analysis, the level of HbA1c was independently associated with the parameters of the LV function and ascending aorta elasticity. CONCLUSIONS T2DM can impair the LV myocardial function and ascending aorta elastic properties, which may be further impaired by poor blood glucose control.
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Affiliation(s)
- Xiang-Ting Song
- Department of Echocardiography, Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China.
| | - Li Fan
- Department of Echocardiography, Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Zi-Ning Yan
- Department of Echocardiography, Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Yi-Fei Rui
- Department of Echocardiography, Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
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17
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Vitamin D 3 Supplementation Alleviates Left Ventricular Dysfunction in a Mouse Model of Diet-Induced Type 2 Diabetes: Potential Involvement of Cardiac Lipotoxicity Modulation. Cardiovasc Drugs Ther 2021; 36:245-256. [PMID: 33661433 DOI: 10.1007/s10557-021-07143-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the effectiveness of vitamin D3 supplementation, in secondary prevention, on cardiac remodeling and function, as well as lipid profile, in a mouse model of diet-induced type 2 diabetes. METHODS Mice were fed a high fat and sucrose diet for 10 weeks. Afterward, diet was maintained for 15 more weeks and two groups were formed, with and without cholecalciferol supplementation. A control group was fed with normal chow. Glucose homeostasis and cardiac function were assessed at baseline and at the 10th and 24th weeks. Animals were killed at the 10th and 25th weeks for plasma and cardiac sample analysis. Cardiac lipid profile was characterized by LC-MS/MS. RESULTS After 10 weeks of diet, mice exhibited pre-diabetes, mild left ventricle hypertrophy, and impaired longitudinal strain, but preserved myocardial circumferential as well as global diastolic and systolic cardiac function. After 15 more weeks of diet, animals presented with well-established type 2 diabetes, pathological cardiac hypertrophy, and impaired regional myocardial function. Cholecalciferol supplementation had no effect on glucose homeostasis but improved cardiac remodeling and regional myocardial function. After 25 weeks, non-supplemented mice exhibited increased myocardial levels of ceramides and diacylglycerol, both of which were normalized by vitamin D3 supplementation. CONCLUSION This work brought to light the beneficial effects of cholecalciferol supplementation, in secondary prevention, on cardiac remodeling and function in a mouse model of diet-induced type 2 diabetes. Those cardioprotective effects may be, at least in part, attributed to the modulation of myocardial levels of lipotoxic species by vitamin D.
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18
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Van Ryckeghem L, Keytsman C, Verbaanderd E, Frederix I, Bakelants E, Petit T, Jogani S, Stroobants S, Dendale P, Bito V, Verwerft J, Hansen D. Asymptomatic type 2 diabetes mellitus display a reduced myocardial deformation but adequate response during exercise. Eur J Appl Physiol 2021; 121:929-940. [PMID: 33417036 DOI: 10.1007/s00421-020-04557-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/07/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE The development of myocardial fibrosis is a major complication of Type 2 diabetes mellitus (T2DM), impairing myocardial deformation and, therefore, cardiac performance. It remains to be established whether abnormalities in longitudinal strain (LS) exaggerate or only occur in well-controlled T2DM, when exposed to exercise and, therefore, cardiac stress. We therefore studied left ventricular LS at rest and during exercise in T2DM patients vs. healthy controls. METHODS AND RESULTS Exercise echocardiography was applied with combined breath-by-breath gas exchange analyses in asymptomatic, well-controlled (HbA1c: 6.9 ± 0.7%) T2DM patients (n = 36) and healthy controls (HC, n = 23). Left ventricular LS was assessed at rest and at peak exercise. Peak oxygen uptake (V̇O2peak) and workload (Wpeak) were similar between groups (p > 0.05). Diastolic (E, e's, E/e') and systolic function (left ventricular ejection fraction) were similar at rest and during exercise between groups (p > 0.05). LS (absolute values) was significantly lower at rest and during exercise in T2DM vs. HC (17.0 ± 2.9% vs. 19.8 ± 2% and 20.8 ± 4.0% vs. 23.3 ± 3.3%, respectively, p < 0.05). The response in myocardial deformation (the change in LS from rest up to peak exercise) was similar between groups (+ 3.8 ± 0.6% vs. + 3.6 ± 0.6%, in T2DM vs. HC, respectively, p > 0.05). Multiple regression revealed that HDL-cholesterol, fasted insulin levels and exercise tolerance accounted for 30.5% of the variance in response of myocardial deformation in the T2DM group (p = 0.002). CONCLUSION Myocardial deformation is reduced in well-controlled T2DM and despite adequate responses, such differences persist during exercise. TRIAL REGISTRATION NCT03299790, initially released 09/12/2017.
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Affiliation(s)
- Lisa Van Ryckeghem
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium. .,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
| | - Charly Keytsman
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Elvire Verbaanderd
- Physical Activity, Sport & Health Research Group, Faculty of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Ines Frederix
- BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Faculty of Medicine & Health Sciences, Antwerp University, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Elise Bakelants
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland
| | - Thibault Petit
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Siddharth Jogani
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Sarah Stroobants
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Paul Dendale
- BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Virginie Bito
- BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jan Verwerft
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Dominique Hansen
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
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19
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Gulsin GS, Brady E, Marsh AM, Squire G, Htike ZZ, Wilmot EG, Biglands JD, Kellman P, Xue H, Webb DR, Khunti K, Yates T, Davies MJ, McCann GP. Clinical associations with stage B heart failure in adults with type 2 diabetes. Ther Adv Endocrinol Metab 2021; 12:20420188211030144. [PMID: 34349975 PMCID: PMC8287269 DOI: 10.1177/20420188211030144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is a high prevalence of asymptomatic (American Heart Association Stage B) heart failure (SBHF) in people with type 2 diabetes (T2D). We aimed to identify associations between clinical characteristics and markers of SBHF in adults with T2D, which may allow therapeutic interventions prior to symptom onset. METHODS Adults with T2D from a multi-ethnic population with no prevalent cardiovascular disease [n = 247, age 52 ± 12 years, glycated haemoglobin A1c (HbA1c) 7.4 ± 1.1% (57 ± 12 mmol/mol), duration of diabetes 61 (32, 120) months] underwent echocardiography and adenosine stress perfusion cardiovascular magnetic resonance imaging. Multivariable linear regression analyses were performed to identify independent associations between clinical characteristics and markers of SBHF. RESULTS In a series of multivariable linear regression models containing age, sex, ethnicity, smoking history, number of glucose-lowering agents, systolic blood pressure (BP) duration of diabetes, body mass index (BMI), HbA1c, serum creatinine, and low-density lipoprotein (LDL)-cholesterol, independent associations with: left ventricular mass:volume were age (β = 0.024), number of glucose-lowering agents (β = 0.022) and systolic BP (β = 0.027); global longitudinal strain were never smoking (β = -1.196), systolic BP (β = 0.328), and BMI (β = -0.348); myocardial perfusion reserve were age (β = -0.364) and male sex (β = 0.458); and aortic distensibility were age (β = -0.629) and systolic BP (β = -0.348). HbA1c was not independently associated with any marker of SBHF. CONCLUSIONS In asymptomatic adults with T2D, age, systolic BP, BMI, and smoking history, but not glycaemic control, are the major determinants of SBHF. Given BP and BMI are modifiable, these may be important targets to reduce the development of symptomatic heart failure.
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Affiliation(s)
| | - Emer Brady
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Gareth Squire
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Zin Z. Htike
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Emma G. Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Peter Kellman
- National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Hui Xue
- National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - David R. Webb
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Melanie J. Davies
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
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20
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Zupo R, Castellana F, Sardone R, Scicchitano P, Lampignano L, Ciccone MM, Triggiani V, Guastamacchia E, Giannelli G, De Pergola G. Impaired fasting plasma glucose is a risk indicator of interventricular septum thickening among non-diabetic subjects with obesity. Diabetes Res Clin Pract 2020; 169:108436. [PMID: 32941960 DOI: 10.1016/j.diabres.2020.108436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/24/2020] [Accepted: 09/06/2020] [Indexed: 11/24/2022]
Abstract
AIMS To evaluate whether progressively higher fasting plasma glucose (FPG) is associated to thickening of the interventricular septum (IVS) among non-diabetic subjects with obesity. METHODOLOGY We studied 227 consecutive non diabetic patients (155 women and 72 men, age range 18-72 years) with overweight or obesity (BMI ≥ 25 Kg/m2), taking no medication or supplement. Hormonal, metabolic and routine laboratory parameters were collected. Echocardiography and ultrasonography echo-color Doppler of intima-media thickness of the common carotid artery (IMT-CCA) were performed to evaluate intima-media thickness of the common carotid artery (IVST) and early signs of atherosclerosis, respectively, in all enrolled subjects. RESULTS Of the 227 subjects, 48.9% had higher IVST values. Age (p 0.04), waist circumference (p 0.01), systolic (p < 0.01) and diastolic blood pressure (p < 0.01), FPG (p < 0.01), insulin (p 0.04), HOMA IR (p = 0.01), uric acid (p < 0.01) serum levels, IMT-CCA (p < 0.01), and left atrial diameter (LAD) (p < 0.01) were significantly higher in subjects with pathological IVST. Logistic regression models demonstrated an independent relation of FPG to IVST, both in semi and fully adjusted models (ORs 1.045 and 1.039, respectively). Moreover, graph presentation of the ORs and 95% CIs by FPG quintiles showed a positive risk trend for pathological IVST. CONCLUSIONS Higher FPG levels represent an independent sensitive predictor of IVS thickening in subjects with obesity, even before overt diabetes. These results emphasize the importance of preventive management of the diabetes risk in obesity.
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Affiliation(s)
- Roberta Zupo
- Population Health Unit - "Salus in Apulia Study" National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Fabio Castellana
- Population Health Unit - "Salus in Apulia Study" National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Rodolfo Sardone
- Population Health Unit - "Salus in Apulia Study" National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Pietro Scicchitano
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO) University of Bari, Bari, Italy.
| | - Luisa Lampignano
- Population Health Unit - "Salus in Apulia Study" National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Marco Matteo Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO) University of Bari, Bari, Italy.
| | - Vincenzo Triggiani
- Section of Internal Medicine, Geriatrics, Endocrinology and Rare Disease, Interdisciplinary Department of Medicine, School of Medicine, University of Bari, Bari, Italy.
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine. Endocrinology and Metabolic Diseases, University of Bari, Bari, Italy.
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Giovanni De Pergola
- Population Health Unit - "Salus in Apulia Study" National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy; Clinical Nutrition Unit, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Bari, Italy.
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21
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Quantitative evaluation of subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus by three-dimensional echocardiography. Int J Cardiovasc Imaging 2020; 36:1311-1319. [DOI: 10.1007/s10554-020-01833-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/30/2020] [Indexed: 12/27/2022]
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22
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Corica D, Oreto L, Pepe G, Calabrò MP, Longobardo L, Morabito L, Pajno GB, Alibrandi A, Aversa T, Wasniewska M. Precocious Preclinical Cardiovascular Sonographic Markers in Metabolically Healthy and Unhealthy Childhood Obesity. Front Endocrinol (Lausanne) 2020; 11:56. [PMID: 32194501 PMCID: PMC7062712 DOI: 10.3389/fendo.2020.00056] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Childhood obesity is related to a wide spectrum of cardiovascular and metabolic comorbidities. Objectives: (1) To identify precocious, preclinical, cardiovascular sonographic modifications, in a cohort of overweight (OW) and obese (OB) children and adolescents compared to lean controls; (2) to investigate the association between clinical and metabolic variables and cardiovascular sonographic parameters; (3) to evaluate their relation with two different phenotypes of obesity: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). Materials and Methods: Fifty-nine OW and OB children and adolescents (9.8 ± 2.9 years) and 20 matched lean controls underwent anthropometric, biochemical, echocardiography assessment, and sonographic evaluation of carotid artery and ascending aorta (AA). OW and OB subjects were divided in MHO and MUO, according to the Camhi et al. definition. Results: OW and OB children showed significantly higher left ventricular (LV) dimensions and mass, carotid artery intima-media thickness (CIMT), carotid stiffness [β-index, pulse wave velocity (PWV)], significantly lower mitral peak early (E) and late (A) velocity ratio (E/A ratio), and significantly impaired global longitudinal strain (GLS) compared to controls. BMI SD and HOMA-IR were positively significantly related to LV dimensions, LA volume and epicardial adipose tissue (EAT), and negative to E/A ratio. Waist circumference (WC) was positively correlated to LV dimensions, LA volume, CIMT, PWV, AA diameter, and EAT. Furthermore, WC was a strong predictor of LV dimensions, LA volume and strain, AA stiffness and diameter; BMI SD was significantly associated with EAT, LVM index, and E/A ratio; HOMA-IR and triglycerides were significant predictors of GLS. MUO patients showed higher BMI SD (p = 0.02), WC (p = 0.001), WHtR (p = 0.001), HOMA-IR (p = 0.004), triglycerides (p = 0.01), SBP (p = 0.001), as well as LV dimensions, EAT (p = 0.03), CIMT (p = 0.01), AA diameter (p = 0.02), β-index (p = 0.03) and PWV (p = 0.002), AA stiffness (p = 0.006), and significantly impaired GLS (p = 0.042) compared to MHO. Conclusions: Severity of overweight, abdominal obesity, insulin resistance, and MUO phenotype negatively affect cardiovascular remodeling and subclinical myocardial dysfunction in OW and OB children. MUO phenotype is likely to increase the risk of developing cardiometabolic complications since the pediatric age. Distinction between MHO and MUO phenotypes might be useful in planning a personalized follow-up approach in obese children.
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Affiliation(s)
- Domenico Corica
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
- *Correspondence: Domenico Corica
| | - Lilia Oreto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Maria Pia Calabrò
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Luca Longobardo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Letteria Morabito
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Giovanni Battista Pajno
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | | | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
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23
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Lin JL, Sung KT, Su CH, Chou TH, Lo CI, Tsai JP, Chang SC, Lai YH, Hu KC, Liu CY, Yun CH, Hung CL, Yeh HI, Lam CSP. Cardiac Structural Remodeling, Longitudinal Systolic Strain, and Torsional Mechanics in Lean and Nonlean Dysglycemic Chinese Adults. Circ Cardiovasc Imaging 2019; 11:e007047. [PMID: 29752393 DOI: 10.1161/circimaging.117.007047] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 03/26/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diabetes mellitus and pre-diabetes mellitus are associated with lower body mass indices and increased risk of cardiovascular events (including heart failure) at lower glucose thresholds in Chinese compared with Western cohorts. However, the extent of cardiac remodeling and regulation on cardiac mechanics in lean and nonlean dysglycemic Chinese adults is understudied. METHODS AND RESULTS We studied 3950 asymptomatic Chinese (aged 49.7±10.7 years; 65% male; body mass index: 24.3±3.5 kg/m2) with comprehensive echocardiography including speckle tracking for left ventricular global longitudinal strain/torsion, with plasma sugar, glycosylated hemoglobin (HbA1c), and insulin resistance (homeostasis model assessment of insulin resistance) obtained. Participants were classified as (1) nondiabetic (fasting glucose <100 mg/mL; HbA1c <5.7%; n=1416), prediabetic (fasting glucose 100-126 mg/dL; HbA1c 5.7%-6.4%; n=2029), or diabetic (n=505) and (2) lean (body mass index <23 kg/m2; n=1445) or nonlean (n=2505). Higher sugar, HbA1c, and homeostasis model assessment of insulin resistance were independently associated with higher left ventricular mass, greater mass-to-volume ratio, more impaired diastolic indices, and worse global longitudinal strain even after adjusting for clinical covariates (adjusted coefficient value: 0.28/0.12 for global longitudinal strain per 1 U HbA1c/homeostasis model assessment of insulin resistance increment; both P<0.001), with a consistent trend toward greater torsion (all trend P<0.001). The optimal cutoffs in identifying subclinical systolic dysfunction (global longitudinal strain more impaired than -18%) for lean versus nonlean individuals were 97 versus 106 mg/dL for fasting sugar, 130 versus 135 mg/mL for postprandial sugar, 5.62% versus 6.28% for HbA1c, and 1.81 versus 2.40 for homeostasis model assessment of insulin resistance, respectively. CONCLUSIONS These data demonstrate the presence of preclinical cardiac remodeling and systolic dysfunction in prediabetic and diabetic Chinese adults, occurring at lower thresholds of glycemic indices than defined by international standards, particularly in lean individuals.
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Affiliation(s)
- Jiun-Lu Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.).,Division of Endocrinology and Metabolism, Department of Internal Medicine (J.-L.L.)
| | - Kuo-Tzu Sung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.).,Division of Cardiology, Department of Internal Medicine (K.-T.S., C.-H.S., C.-I.L., J.-P.T., C.-L.H., H.-I.Y.)
| | - Cheng-Huang Su
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.).,Division of Cardiology, Department of Internal Medicine (K.-T.S., C.-H.S., C.-I.L., J.-P.T., C.-L.H., H.-I.Y.)
| | | | - Chi-In Lo
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.).,Division of Cardiology, Department of Internal Medicine (K.-T.S., C.-H.S., C.-I.L., J.-P.T., C.-L.H., H.-I.Y.)
| | - Jui-Peng Tsai
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.).,Division of Cardiology, Department of Internal Medicine (K.-T.S., C.-H.S., C.-I.L., J.-P.T., C.-L.H., H.-I.Y.)
| | - Shun-Chuan Chang
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.)
| | - Yau-Huei Lai
- MacKay Memorial Hospital, Taipei, Taiwan. Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan (Y.-H.L.)
| | - Kuang-Chun Hu
- Health Evaluation Center (K.-C.H., C.-Y.L.).,Division of Gastroenterology, Department of Internal Medicine (K.-C.H., C.-Y.L.)
| | - Chia-Yuan Liu
- Health Evaluation Center (K.-C.H., C.-Y.L.).,Division of Gastroenterology, Department of Internal Medicine (K.-C.H., C.-Y.L.)
| | - Chun-Ho Yun
- Health Evaluation Center (K.-C.H., C.-Y.L.).,and Department of Radiology (C.-H.Y.)
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.). .,Division of Cardiology, Department of Internal Medicine (K.-T.S., C.-H.S., C.-I.L., J.-P.T., C.-L.H., H.-I.Y.).,Institute of Clinical Medicine (C.-L.H.).,and Cardiovascular Research Center (C.-L.H.)
| | - Hung-I Yeh
- Division of Cardiology, Department of Internal Medicine (K.-T.S., C.-H.S., C.-I.L., J.-P.T., C.-L.H., H.-I.Y.)
| | - Carolyn S P Lam
- National Yang-Ming University, Taipei, Taiwan. National Heart Centre Singapore (C.S.P.L.).,Duke-National University of Singapore (C.S.P.L.)
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24
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Tang X, Zhong J, Zhang H, Luo Y, Liu X, Peng L, Zhang Y, Qian X, Jiang B, Liu J, Li S, Chen Y. Visit-to-visit fasting plasma glucose variability is an important risk factor for long-term changes in left cardiac structure and function in patients with type 2 diabetes. Cardiovasc Diabetol 2019; 18:50. [PMID: 30992008 PMCID: PMC6469221 DOI: 10.1186/s12933-019-0854-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/05/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To investigate the effect of visit-to-visit fasting plasma glucose (FPG) variability on the left cardiac structure and function in patients with type 2 diabetes mellitus (T2DM). METHODS In this prospective cohort study, 455 T2DM patients were included and follow-up for a median of 4.7 years. FPG measured on every hospital visit was collected. FPG variability was calculated by its coefficient of variation (CV-FPG). Left cardiac structure and function were assessed using echocardiography at baseline and after follow-up. Multivariable linear regression analyses were used to estimate the effect of FPG variability on the annualized changes in left cardiac structure and function. Subgroup analysis stratified by mean HbA1c levels (< 7% and ≥ 7%) were also performed. RESULT In multivariable regression analyses, CV-FPG was independently associated with the annualized changes in left ventricle (β = 0.137; P = 0.031), interventricular septum (β = 0.215; P = 0.001), left ventricular posterior wall thickness (β = 0.129; P = 0.048), left ventricular mass index (β = 0.227; P < 0.001), and left ventricular ejection fraction (β = - 0.132; P = 0.030). After additionally stratified by mean HbA1c levels, CV-FPG was still independently associated with the annualized changes in the above parameters in patients with HbA1c ≥ 7%, while not in patients with HbA1c < 7%. CONCLUSIONS Visit-to-visit variability in FPG could be a novel risk factor for the long-term adverse changes in left cardiac structure and systolic function in patients with type 2 diabetes. Trial registration ClinicalTrials.gov (NCT02587741), October 27, 2015, retrospectively registered.
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Affiliation(s)
- Xixiang Tang
- Department of Endocrinology & Metabosim, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China.,Advanced Medical Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Junlin Zhong
- Department of Ultrasonography, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Hui Zhang
- Department of Ultrasonography, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Yanting Luo
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Xing Liu
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Long Peng
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Yanling Zhang
- Department of Ultrasonography, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Xiaoxian Qian
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Boxiong Jiang
- Advanced Medical Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Jinlai Liu
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Suhua Li
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China.
| | - Yanming Chen
- Department of Endocrinology & Metabosim, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China.
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25
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Gulsin GS, Athithan L, McCann GP. Diabetic cardiomyopathy: prevalence, determinants and potential treatments. Ther Adv Endocrinol Metab 2019; 10:2042018819834869. [PMID: 30944723 PMCID: PMC6437329 DOI: 10.1177/2042018819834869] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/08/2019] [Indexed: 12/18/2022] Open
Abstract
The prevalence of type 2 diabetes (T2D) has reached a pandemic scale. These patients are at a substantially elevated risk of developing cardiovascular disease, with heart failure (HF) being a leading cause of morbidity and mortality. Even in the absence of traditional risk factors, diabetes still confers up to a twofold increased risk of developing HF. This has led to identifying diabetes as an independent risk factor for HF and recognition of the distinct clinical entity, diabetic cardiomyopathy. Despite a wealth of research interest, the prevalence and determinants of diabetic cardiomyopathy remain uncertain. This limited understanding of the pathophysiology of diabetic heart disease has also hindered development of effective treatments. Tight blood-glucose and blood-pressure control have not convincingly been shown to reduce macrovascular outcomes in T2D. There is, however, emerging evidence that T2D is reversible and that the metabolic abnormalities can be reversed with weight loss. Increased aerobic exercise capacity is associated with significantly lower cardiovascular and overall mortality in diabetes. Whether such lifestyle modifications as weight loss and exercise may ameliorate the structural and functional derangements of the diabetic heart has yet to be established. In this review, the link between T2D and myocardial dysfunction is explored. Insights into the structural and functional perturbations that typify the diabetic heart are first described. This is followed by an examination of the pathophysiological mechanisms that contribute to the development of cardiovascular disease in T2D. Lastly, the current and emerging therapeutic strategies to prevent or ameliorate cardiac dysfunction in T2D are evaluated.
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Affiliation(s)
- Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
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26
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Ten Years of 2D Longitudinal Strain for Early Myocardial Dysfunction Detection: A Clinical Overview. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8979407. [PMID: 30627581 PMCID: PMC6304576 DOI: 10.1155/2018/8979407] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/05/2018] [Accepted: 10/30/2018] [Indexed: 12/30/2022]
Abstract
In recent years, the role of left ventricular ejection fraction (EF) as the gold standard parameter for the evaluation of systolic function has been questioned, and many efforts have been concentrated in the clinical validation of new noninvasive tools for the study of myocardial contractility. Improvement in the accuracy of speckle-tracking echocardiography has resulted in a large amount of research showing the ability of two-dimensional strain to overcome EF limitations in the majority of primary and secondary heart diseases. Currently, global longitudinal strain (GLS) is considered the most accurate and sensitive parameter for the assessment of early left ventricular dysfunction. This review summarizes the advantages that this measurement can provide in several clinical settings. Moreover, the important cautions that should be considered in making the choice to use GLS also are addressed. Finally, a special focus on bull's-eye polar maps for the assessment of regional changes of longitudinal function and the usefulness of these maps in the differential diagnosis of several diseases is provided.
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Omidi F, Hosseinsabet A. Is the longitudinal deformation of the left ventricle affected by vitamin D deficiency in nondiabetics? A 2D speckle-tracking echocardiographic study. Echocardiography 2018; 36:67-73. [PMID: 30480338 DOI: 10.1111/echo.14205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/10/2018] [Accepted: 10/20/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Vitamin D deficiency with its high global prevalence is associated with some pathological changes in the myocardium. The aim of our study was to assess the longitudinal deformation of the left ventricular (LV) myocardium in subjects with vitamin D deficiency. METHODS This cross-sectional study recruited 98 consecutive nondiabetic subjects (45 subjects with vitamin D deficiency and 53 subjects without vitamin D deficiency) without significant epicardial coronary artery stenosis. The longitudinal subendocardial deformation indices of the LV myocardium were evaluated with 2D speckle-tracking echocardiography. RESULTS The end-systolic strain, the systolic strain rate, and the early and late diastolic strain rates were not statistically significantly different between the subjects with and without vitamin D deficiency. CONCLUSIONS The global longitudinal subendocardial deformations of the LV, including the systolic strain rate and the systolic and diastolic strain rates, as evaluated with 2D speckle-tracking echocardiography were not statistically significantly correlated with the presence or absence of vitamin D deficiency.
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Affiliation(s)
- Fatemeh Omidi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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El Razaky O, El Amrousy D, Elrifaey S, Elgendy M, Ibrahim W. Three-dimensional speckle tracking echocardiography: Is it the magic wand in the diagnosis of subclinical myocardial dysfunction in children with type 1 diabetes mellitus? Echocardiography 2018; 35:1657-1663. [PMID: 29981180 DOI: 10.1111/echo.14095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To revaluate the role of three-dimensional speckle tracking echocardiography (3D-STE) in the evaluation of subclinical myocardial dysfunction in asymptomatic children with type 1 diabetes mellitus (DM). PATIENTS AND METHODS Fifty asymptomatic children with type 1 DM were included as a patient group. Fifty healthy children of matched age, sex, and weight served as a control group. Laboratory investigations in the form of complete blood count (CBC), liver function test, renal function test, complete blood lipid profile, glycosylated hemoglobin (HbA1c), fasting and 2 hours postprandial (PP) glucose levels, and cardiac troponin I (cTnT I) were drawn. Complete echocardiographic evaluation of the left ventricular (LV) function was performed in the form of conventional echo, 2D strain, tissue Doppler imaging (TDI), and 3D- STE. RESULTS cTnT I levels were significantly higher in the patient group than the control group, and this increase was significantly correlated with Hb A1c. Conventional echocardiography showed normal systolic and diastolic function of the LV. Diastolic (by TDI) as well as systolic functions of LV (by 4D LV quantification tool) were found to be significantly lower in patient group than control group. 3D-STE examination showed that there was a significant decrease in all component of strain in patient group than control group and that decrease correlated well with 4D LV EF but did not correlate with the duration of DM. There was a significant negative correlation between longitudinal strain and the control of DM. CONCLUSION 3D-STE is a good tool for prediction of early cardiac dysfunction in asymptomatic children with type 1 DM.
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Affiliation(s)
- Osama El Razaky
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | - Doaa El Amrousy
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | | | - Marwa Elgendy
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | - Wesam Ibrahim
- Clinical Pathology Department, Tanta University Hospital, Tanta, Egypt
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Philouze C, Obert P, Nottin S, Benamor A, Barthez O, Aboukhoudir F. Dobutamine Stress Echocardiography Unmasks Early Left Ventricular Dysfunction in Asymptomatic Patients with Uncomplicated Type 2 Diabetes: A Comprehensive Two-Dimensional Speckle-Tracking Imaging Study. J Am Soc Echocardiogr 2018. [PMID: 29526563 DOI: 10.1016/j.echo.2017.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Discrepancies are present in the literature on resting myocardial mechanics in patients with uncomplicated type 2 diabetes mellitus (T2DM). Data are noticeably sparse regarding circumferential function and torsional mechanics. Resting deformation imaging may not be sensitive enough to detect subtle dysfunctions. The aim of this study was thus to comprehensively evaluate myocardial mechanics in patients with T2DM at rest and to investigate whether dobutamine stress echocardiography could unmask functional alterations that would remain otherwise subtle at rest. METHODS Forty-four patients with T2DM and 35 healthy control subjects of similar age and sex were prospectively recruited. After conventional echocardiography, myocardial mechanics was evaluated at rest and during low-dose dobutamine stress echocardiography (target heart rate, 110 beats/min). RESULTS Patients with T2DM presented with altered global diastolic function but preserved systolic function. Deformation imaging indexes were similar between groups at rest, but significant differences were noticed under dobutamine infusion for longitudinal strain (-21.2 ± 2.4% vs -24.2 ± 2.5%, P < .001), circumferential strain (apex, -32.3 ± 5.3% vs -36.3 ± 5.3%, P = .002; papillary muscle, -25.6 ± 3.2% vs -28.0 ± 3.6%, P = .001; base, -23.2 ± 3.6% vs -25.3 ± 3.8%, P = .03), apical (11.2 ± 4.4° vs 14.1 ± 6.3°, P = .020) and basal (-12.2 ± 3.3° vs -14.3 ± 3.9°, P = .021) rotation, and twist (21.9 ± 5.9° vs 26.8 ± 8.3°, P = .007). Multivariate analysis identified epicardial fat, dyslipidemia, and fasting glycaemia as significant contributors to the changes from rest to dobutamine. CONCLUSIONS These findings demonstrate the usefulness of dobutamine stress echocardiography in establishing impairments in myocardial mechanics in patients with uncomplicated T2DM. Systemic metabolic disturbances and epicardial fat act as the main contributors to the blunted response to dobutamine stress in these patients.
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Affiliation(s)
- Clothilde Philouze
- EA4278 LaPEC, Laboratory of Cardiovascular Pharm-Ecology, Avignon University, Avignon, France
| | - Philippe Obert
- EA4278 LaPEC, Laboratory of Cardiovascular Pharm-Ecology, Avignon University, Avignon, France
| | - Stéphane Nottin
- EA4278 LaPEC, Laboratory of Cardiovascular Pharm-Ecology, Avignon University, Avignon, France
| | - Asma Benamor
- EA4278 LaPEC, Laboratory of Cardiovascular Pharm-Ecology, Avignon University, Avignon, France
| | - Olivier Barthez
- Cardiology Department, Duffaut Hospital Center, Avignon, France
| | - Falah Aboukhoudir
- EA4278 LaPEC, Laboratory of Cardiovascular Pharm-Ecology, Avignon University, Avignon, France; Cardiology Department, Duffaut Hospital Center, Avignon, France.
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Wang Q, Tan K, Xia H, Gao Y. Left ventricular structural alterations are accompanied by subclinical systolic dysfunction in type 2 diabetes mellitus patients with concomitant hyperlipidemia: An analysis based on 3D speckle tracking echocardiography. Echocardiography 2018; 35:965-974. [PMID: 29509974 DOI: 10.1111/echo.13858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS The aims of the current study were to analyze and compare the left ventricular (LV) structure and function in type 2 diabetes mellitus (T2DM) patients with or without hyperlipidemia using conventional echocardiography and real-time three-dimensional speckle tracking echocardiography (3DSTE) and to determine the variables that could affect LV strain values in these patients. METHODS Eighty-one T2DM patients with normal LVEF (≥55%) were included, 41 of whom had hyperlipidemia as comorbidity. Forty age- and gender-matched healthy volunteers were recruited as the control group. Conventional echocardiography and 3DSTE were performed, and LV global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were measured. RESULTS Significant differences in two-dimensional LV geometry were found among three groups (P = .015). Compared with the control group, LV remodeling was more prevalent in the patients with T2DM, and LV hypertrophy was most prevalent in the T2DM patients with hyperlipidemia. GLS and GCS values decreased significantly in the T2DM patients without hyperlipidemia relative to the control group (P < .01 and P < .05). The GLS, GCS, GAS, and GRS values in the T2DM patients with hyperlipidemia were all significantly lower than those in the control group (all P < .001) and were also significantly lower than those in the T2DM patients without hyperlipidemia (P < .01 or P < .05). Both fasting plasma glucose (FPG) and hyperlipidemia were independently associated with all strain values in patients with T2DM. CONCLUSIONS The combination of conventional echocardiography and 3DSTE could detect subclinical LV abnormalities in T2DM patients with or without hyperlipidemia.
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Affiliation(s)
- Qingqing Wang
- Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Kaibin Tan
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Hongmei Xia
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Yunhua Gao
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
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Zhong Y, Bai W, Rao LI. Does Pulmonary Involvement Play a Role in Right Ventricular Dysfunction of Patients with Idiopathic Inflammatory Myopathies? J Rheumatol 2018; 45:288. [PMID: 29419451 DOI: 10.3899/jrheum.170686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Yue Zhong
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Wenjuan Bai
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - L I Rao
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.
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Mehta S, Khoury PR, Madsen NL, Dolan LM, Kimball TR, Urbina EM. Arterial Thickness and Stiffness Are Independently Associated with Left Ventricular Strain. J Am Soc Echocardiogr 2018; 31:99-104. [PMID: 29174337 PMCID: PMC5756686 DOI: 10.1016/j.echo.2017.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The aim of this study was to examine the association between myocardial strain and arterial thickness and stiffness in young adults. Increased common carotid artery intima media thickness and peripheral arterial stiffness are known to precede coronary artery disease and cardiovascular (CV) events such as myocardial infarction and congestive heart failure. However, subclinical cardiac dysfunction can be detected in high-risk adults by myocardial strain echocardiography. The authors hypothesized that increased carotid artery intima media thickness would be associated with abnormal myocardial strain in young subjects who had obesity and type 2 diabetes mellitus. METHODS CV risk factors were collected in 338 young adults participating in a prospective, cross-sectional study. The CV parameters collected included intima-media thickness, peripheral arterial stiffness by brachial distensibility, and myocardial strain and strain rate. General linear models were constructed to determine if vascular structure and function measures were independently associated with myocardial strain and strain rate. RESULTS A linear relationship was found between global longitudinal strain obtained from the four-chamber view and global strain rate in systole and carotid intima-media thickness (four-chamber global longitudinal strain: β = 3.0, CV risk factor-adjusted R2 = 0.34; global strain rate in systole: β = 0.0053, R2 = 0.21; P ≤ .0001) and between four-chamber global longitudinal strain and lower brachial distensibility (β = -0.42, R2 = 0.22; P < .001). CONCLUSIONS Adverse changes in vascular structure and function are simultaneously present with reduced myocardial systolic function.
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Affiliation(s)
- Smita Mehta
- Preventive Cardiology, Dayton Children's Hospital, Dayton, Ohio
| | - Philip R Khoury
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nicolas L Madsen
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lawrence M Dolan
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Thomas R Kimball
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Elaine M Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Luo Y, Liu Y, Guan X, Zhang Y, Li J. Value of three dimensional-speckle tracking imaging for predicting left ventricular function after non-ST-segment elevation myocardial infarction with percutaneous coronary intervention. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2018; 26:331-339. [PMID: 29562571 DOI: 10.3233/xst-17316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is the recommended treatment for high risk patients with non-ST-segment elevation myocardial infarction (NSTEMI). OBJECTIVE To investigate the application of three dimensional-speckle tracking imaging (3D-STI) on patients diagnosed with NSTEMI undergoing PCI. METHODS Forty-four NSTEMI patients and 20 healthy subjects that received basic clinical and laboratory examinations were included in our study. NSTEMI patients were divided into three groups: heart failure (HF) with normal ejection fraction (HF-NEF group, n = 19), heart failure with preserved ejection fraction (HF-PEF group, n = 14) and heart failure with a reduced ejection fraction (HF-REF group, n = 11). The global longitudinal peak systolic strain (GLS), global circumferential peak systolic strain (GCS), global radial peak systolic strain (GRS) and left ventricular (LV) torsion of all subjects were measured by 3D-STI before PCI and 1 month, 3 months after PCI. The high-sensitivity troponin T (hs-TNT), high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-brain natriuretic peptide (NT-pro BNP) were measured in each group. Correlations between these parameters and LV ejection fraction (LVEF) were tested by Pearson correlation analysis. RESULTS GLS, GCS and torsion were significantly decreased in the 3 NSTEMI groups compared with control group (P < 0.05). GLS, torsion were significantly improved in the three NSTEMI groups at postoperative 1 and 3 months (P < 0.05). HF-REF group showed improved GCS on postoperative 1 and 3 month compared with preoperative data, and improved GLS at 3-month follow-up compared with 1-month follow-up (P < 0.05). The hs-TNT, hs-CRP and NT-pro BNP increased in the three NSTEMI groups before PCI (P < 0.05), and decreased at postoperative 1 and 3 month (P < 0.05). LVEF has the positive correlations with LV endsystolic volume (LVESV) and torsion, as well as the negative correlations with LVGLS, LVGCS, NT-pro BNP (P < 0.05). CONCLUSIONS The combinative detection of 3D-STI and NT-pro BNP is an efficient way to assess the cardiac function in patients diagnosed with NSTEMI undergoing PCI.
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Affiliation(s)
- Yongjuan Luo
- Department of Ultrasound, Tianjin Chest Hospital, China
| | - Yujie Liu
- Department of Cardiovascular Medicine, Tianjin Chest Hospital, China
| | - Xin Guan
- Department of Ultrasound, Tianjin Chest Hospital, China
| | - Ying Zhang
- Department of Cardiovascular Medicine, Tianjin Chest Hospital, China
| | - Jing Li
- Department of Cardiovascular Medicine, Tianjin Chest Hospital, China
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van den Dorpel MMP, Heinonen I, Snelder SM, Vos HJ, Sorop O, van Domburg RT, Merkus D, Duncker DJ, van Dalen BM. Early detection of left ventricular diastolic dysfunction using conventional and speckle tracking echocardiography in a large animal model of metabolic dysfunction. Int J Cardiovasc Imaging 2017; 34:743-749. [PMID: 29234934 PMCID: PMC5889412 DOI: 10.1007/s10554-017-1287-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/01/2017] [Indexed: 11/26/2022]
Abstract
Left ventricular (LV) diastolic dysfunction is one of the important mechanisms responsible for symptoms in patients with heart failure. The aim of the current study was to identify parameters that may be used to detect early signs of LV diastolic dysfunction in diabetic pigs on a high fat diet, using conventional and speckle tracking echocardiography. The study population consisted of 16 healthy Göttingen minipigs and 18 minipigs with experimentally induced metabolic dysfunction. Echocardiography measurements were performed at baseline and 3-month follow-up. The ratio of peak early (E) and late filling velocity (E/A ratio) and the ratio of E and the velocity of the mitral annulus early diastolic wave (E/Em ratio) did not change significantly in both groups. Peak untwisting velocity decreased in the metabolic dysfunction group (- 30.1 ± 18.5 vs. - 23.4 ± 15.5 °/ms) but not in controls (- 38.1 ± 23.6 vs. - 42.2 ± 23.0 °/ms), being significantly different between the groups at the 3-month time point (p < 0.05). In conclusion, whereas E/A ratio and E/Em ratio did not change significantly after 3 months of metabolic dysfunction, peak untwisting velocity was significantly decreased. Hence, peak untwisting velocity may serve as an important marker to detect early changes of LV diastolic dysfunction.
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Affiliation(s)
- Mark M P van den Dorpel
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ilkka Heinonen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku, Finland
| | - Sanne M Snelder
- Department of Cardiology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Hendrik J Vos
- Division of Biomedical Engineering, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Oana Sorop
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ron T van Domburg
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Daphne Merkus
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
- Department of Cardiology, Franciscus Gasthuis, Rotterdam, The Netherlands.
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Ringle A, Dornhorst A, Rehman MB, Ruisanchez C, Nihoyannopoulos P. Evolution of subclinical myocardial dysfunction detected by two-dimensional and three-dimensional speckle tracking in asymptomatic type 1 diabetic patients: a long‑term follow-up study. Echo Res Pract 2017; 4:73-81. [PMID: 29167183 PMCID: PMC5704514 DOI: 10.1530/erp-17-0052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/03/2017] [Indexed: 12/19/2022] Open
Abstract
Background We sought to assess the long-term evolution of left ventricular (LV) function using two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography (STE) for the detection of preclinical diabetic cardiomyopathy, in asymptomatic type 1 diabetic patients, over a 6-year follow-up. Design and methods Sixty-six asymptomatic type 1 diabetic patients with no cardiovascular risk factors were compared to 26 matched healthy controls. Conventional, 2D and 3D-STE were performed at baseline. A subgroup of 14 patients underwent a 6-year follow-up evaluation. Results At baseline, diabetic patients had similar LV ejection fraction (60 vs 61%; P = NS), but impaired longitudinal function, as assessed by 2D-global longitudinal strain (GLS) (−18.9 ± 2 vs −20.5 ± 2; P = 0.0002) and 3D-GLS (−17.5 ± 2 vs −19 ± 2; P = 0.003). At follow-up, diabetic patients had worsened longitudinal function compared to baseline (2D-GLS: −18.4 ± 1 vs −19.2 ± 1; P = 0.03). Global circumferential (GCS) and radial (GRS) strains were unchanged at baseline and during follow-up. Metabolic status did not correlate with GLS, whereas GCS and GRS showed a good correlation, suggestive of a compensatory increase of circumferential and radial functions in advanced stages of the disease – long-term diabetes (GCS: −26 ± 3 vs −23.3 ± 3; P = 0.008) and in the presence of microvascular complications (GRS: 38.8 ± 9 vs 34.3 ± 8; P = 0.04). Conclusions Subclinical myocardial dysfunction can be detected by 2D and 3D-STE in type 1 diabetic patients, independently of any other cardiovascular risk factors. Diabetic cardiomyopathy progression was suggested by a mild decrease in longitudinal function at the follow-up, but did not extend to a clinical expression of the disease, as no death or over heart failure was reported.
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Affiliation(s)
- Anne Ringle
- Department of Cardiology, Hôpital Saint Philibert, GHICL, Lille, France.,Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Anne Dornhorst
- Department of Diabetes and Endocrinology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Michaela B Rehman
- Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK.,Department of Cardiology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Cristina Ruisanchez
- Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK.,Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain
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Natali A, Nesti L, Fabiani I, Calogero E, Di Bello V. Impact of empagliflozin on subclinical left ventricular dysfunctions and on the mechanisms involved in myocardial disease progression in type 2 diabetes: rationale and design of the EMPA-HEART trial. Cardiovasc Diabetol 2017; 16:130. [PMID: 29025406 PMCID: PMC5639750 DOI: 10.1186/s12933-017-0615-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/05/2017] [Indexed: 02/06/2023] Open
Abstract
Background Asymptomatic left ventricular (LV) dysfunction is highly prevalent in type 2 diabetes patients. Unlike the other hypoglycemic drugs, SGLT2 inhibitors have shown potential benefits for reducing cardiovascular death and risk factors, aside from lowering plasma glucose levels. With this study we aim at determining whether the treatment with empagliflozin is associated with an improvement in LV functions in diabetic patients with asymptomatic LV dysfunction against Sitagliptin, which is presumably neutral on myocardial function. To determine changes in LV systolic and diastolic functions we will use speckle-tracking echocardiography, a novel sensitive, non-invasive, bedside method allowing the calculation of LV global longitudinal strain (GLS), an index of myocardial deformability, as well as 3D echocardiography, which allows a better evaluation of LV volumes and mass. Methods The EMPA-HEART trial will be a phase III, open label, active-controlled, parallel groups, single centre, exploratory study conducted in Pisa, Italy. A cohort of 75 diabetic patients with normal LV systolic (2D-Echo EF > 50%) and renal (eGFR sec MDRD > 60 ml/min/1.73 mq) functions and no evidence of valvular and/or ischemic heart disease will be randomized to either Empagliflozin 10 mg/die or Sitagliptin 100 mg/die. The primary outcome is to detect a change in GLS from baseline to 1 and 6 months after treatment initiation. The secondary outcomes include changes from baseline to 6 months in 3-D Echocardiography EF, left atrial volume and E/E′, VO2max as measured at cardiopulmonary test, cardiac autonomic function tests (R–R interval during Valsalva manoeuvre, deep-breathing, lying-to-standing), and the determination of a set of plasma biomarkers aimed at studying volume, inflammation, oxidative stress, matrix remodelling, myocyte strain and injury. Discussion SGLT2 inhibitors might affect myocardial functions through mechanisms acting both directly and indirectly on the myocardium. The set of instrumental and biohumoral tests of our study might actually detect the presence and entity of empagliflozin beneficial effects on the myocardium and shed light on the mechanisms involved. Further, this study might eventually provide information to design a clinical strategy, based on echocardiography and/or biomarkers, to select the patients who might benefit more from this intervention. Trial registration EUDRACT Code 2016-0022250-10
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Affiliation(s)
- Andrea Natali
- Department of Clinical and Experimental Medicine, Pisa University, Via Savi 27, 56100, Pisa, Italy
| | - Lorenzo Nesti
- Department of Clinical and Experimental Medicine, Pisa University, Via Savi 27, 56100, Pisa, Italy.
| | - Iacopo Fabiani
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, Pisa University, Pisa, Italy
| | - Enrico Calogero
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, Pisa University, Pisa, Italy
| | - Vitantonio Di Bello
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, Pisa University, Pisa, Italy
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Piras P, Torromeo C, Evangelista A, Gabriele S, Esposito G, Nardinocchi P, Teresi L, Madeo A, Schiariti M, Varano V, Puddu PE. Homeostatic Left Heart integration and disintegration links atrio-ventricular covariation's dyshomeostasis in Hypertrophic Cardiomyopathy. Sci Rep 2017; 7:6257. [PMID: 28740203 PMCID: PMC5524707 DOI: 10.1038/s41598-017-06189-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/07/2017] [Indexed: 12/29/2022] Open
Abstract
Left ventricle and left atrium are and have been practically always analyzed separately in common clinically and non-clinically oriented cardiovascular investigations. Both classic and speckle tracking echocardiographic data contributed to the knowledge about deformational impairments occurring in systo-diastolic differences. Recently new trajectory based approaches allowed a greater awareness about the entire left ventricle or left atrium revolution and on their deficiencies that take place in presence of hypertrophic cardiomyopathy. However, surprisingly, the concomitant function of the two left heart chambers has not been analyzed for their geometrical/mechanical relationship. For the first time we study here, by acquiring left ventricle and left atrial geometries on the same heartbeat, the trajectory attributes of the entire left heart treated as a whole shape and the shape covariation of its two subunits. We contrasted healthy subjects with patients affected by hypertrophic cardiomyopathy. We found impaired left heart trajectory mainly in terms of orientation and size. More importantly, we found profound differences in the direction of morphological covariation of left ventricle and left atrium. These findings open to new perspectives in pathophysiological evaluation of different diseases by allowing the appreciation of concomitant functioning of both left heart whole geometry and of its two chambers.
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Affiliation(s)
- Paolo Piras
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy.,Dipartimento di Ingegneria Strutturale e Geotecnica, Sapienza - Università di Roma, Rome, Italy
| | - Concetta Torromeo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy
| | | | - Stefano Gabriele
- Dipartimento di Architettura, LaMS - Modeling & Simulation Lab, Università Roma Tre, Rome, Italy
| | - Giuseppe Esposito
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy
| | - Paola Nardinocchi
- Dipartimento di Ingegneria Strutturale e Geotecnica, Sapienza - Università di Roma, Rome, Italy
| | - Luciano Teresi
- Dipartimento di Matematica e Fisica, LaMS - Modeling & Simulation Lab, Università Roma Tre, Rome, Italy
| | - Andrea Madeo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy
| | - Michele Schiariti
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy
| | - Valerio Varano
- Dipartimento di Architettura, LaMS - Modeling & Simulation Lab, Università Roma Tre, Rome, Italy
| | - Paolo Emilio Puddu
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy.
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Assessment of left ventricular systolic function in patients with iron deficiency anemia by three-dimensional speckle-tracking echocardiography. Anatol J Cardiol 2017. [PMID: 28639946 PMCID: PMC5689050 DOI: 10.14744/anatoljcardiol.2017.7694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective: The present study aimed to evaluate left ventricular (LV) systolic function in patients with iron deficiency anemia (IDA) by 3-dimensional speckle-tracking echocardiography (3DSTE). Methods: Participants were grouped by hemoglobin (Hb) levels in order to study the effect of anemia on cardiac function. Group A included 40 healthy volunteers. Eighty-three patients who were diagnosed with IDA were divided into 2 groups according to the Hb level. Group B (Hb 9 g/dL) included 44 patients, while group C (Hb 6–9 g/dL) included 39 patients. Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF) were calculated by real-time 3-dimensional echocardiography (RT3D). Left ventricular global longitudinal strain (GLS), global area strain (GAS), global radial strain (GRS), and global circumferential strain (GCS) were obtained by 3DSTE. Results: LVMI, LVEDV and LVESV of group C increased and GCS, GRS, GLS, and GAS of group C decreased compared with those of groups A and B (all p<0.05). GAS and GLS decreased significantly compared with other parameters (both p<0.01). Conclusion: LV remodeling and LV systolic dysfunction occurred in patients when the hemoglobin level was in the range of 6–9 g/dL. 3DSTE can evaluate LV systolic function in patients with IDA, and GAS and GLS are more sensitive than other parameters.
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Zoppini G, Bergamini C, Bonapace S, Rossi A, Trombetta M, Mantovani A, Toffalini A, Lanzoni L, Bertolini L, Zenari L, Bonora E, Targher G. Association between subclinical left ventricular systolic dysfunction and glycemic control in asymptomatic type 2 diabetic patients with preserved left ventricular function. J Diabetes Complications 2017; 31:1035-1040. [PMID: 28258906 DOI: 10.1016/j.jdiacomp.2017.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Type 2 diabetes is strongly associated with the occurrence of cardiovascular diseases, especially heart failure. Some studies have suggested that subclinical systolic dysfunction as assessed by tissue Doppler imaging (TDI) is already present in uncomplicated diabetic patients with normal left ventricular ejection fraction (LVEF). Considering the importance of this aspect, the aim of this cross-sectional study was to examine the relationship between glycated hemoglobin and mean s' wave velocity (a reliable measure of early LV systolic dysfunction) in a cohort of type 2 diabetic outpatients with preserved LVEF and without ischemic heart disease. METHODS Forty-four male patients with newly diagnosed and 172 male patients with established type 2 diabetes were recruited for this cross-sectional study. All patients were evaluated with a transthoracic echocardiographic Doppler. The statistical analysis was conducted by a linear multivariate regression analysis, including several potential confounders. RESULTS The mean values of mean s' wave velocity were lower in patients with a worse glycemic control and progressively decreased across the quartiles of glycated hemoglobin. The multivariate linear regression analysis showed that mean s' wave velocity was inversely and independently associated with glycated hemoglobin (standardized beta coefficient -0.178; p = 0.043) after adjustment for age, duration of diabetes, body mass index, pulse pressure, estimated glomerular filtration rate, microvascular complication status, and indexed cardiac mass. CONCLUSIONS These results suggest that s' wave velocity, as evaluated by TDI echocardiography, was an early marker of systolic dysfunction in type 2 diabetic patients with preserved LVEF and without prior ischemic heart disease. Moreover, early systolic dysfunction was independently associated with poor glycemic control in these patients. Future studies are needed to elucidate the pathogenic role of chronic hyperglycemia in the development of early LV systolic dysfunction.
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Affiliation(s)
- Giacomo Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
| | - Corinna Bergamini
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Andrea Rossi
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Maddalena Trombetta
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Anna Toffalini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Laura Lanzoni
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Lorenzo Bertolini
- Division of General Medicine and Diabetes Unit, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Luciano Zenari
- Division of General Medicine and Diabetes Unit, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
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Salem ESB, Fan GC. Pathological Effects of Exosomes in Mediating Diabetic Cardiomyopathy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 998:113-138. [PMID: 28936736 DOI: 10.1007/978-981-10-4397-0_8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetic subjects are at risk of developing cardiovascular disease, which accounts for 60-80% of diabetes-related mortality. Atherosclerosis is still considered as a leading cause of heart failure in diabetic patients, but it could also be an intrinsic and long-term effect of contractile cardiac cells malfunction, known as diabetic cardiomyopathy (DCM). Pathologically, this cardiac dysfunction is manifested by inflammation, apoptosis, fibrosis, hypertrophy and altered cardiomyocytes metabolism. However, the underlying molecular mechanisms of DCM pathophysiology are not clearly understood. Recent and several studies have suggested that exosomes are contributed to the regulation of cell-to-cell communication. Therefore, their in-depth investigation can interpret the complex pathophysiology of DCM. Structurally, exosomes are membrane-bounded vesicles (10-200 nm in diameter), which are actively released from all types of cells and detected in all biological fluids. They carry a wide array of bioactive molecules, including mRNAs, none-coding RNAs (e.g., microRNAs, lncRNAs, circRNAs, etc), proteins and lipids. Importantly, the abundance and nature of loaded molecules inside exosomes fluctuate with cell types and pathological conditions. This chapter summarizes currently available studies on the exosomes' role in the regulation of diabetic cardiomyopathy. Specifically, the advances on the pathological effects of exosomes in diabetic cardiomyopathy as well as the therapeutic potentials and perspectives are also discussed.
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Affiliation(s)
- Esam S B Salem
- Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, 5872 Care Mail Loc-0575, Cincinnati, OH, 45267, USA
| | - Guo-Chang Fan
- Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, 5872 Care Mail Loc-0575, Cincinnati, OH, 45267, USA.
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Hosseinsabet A, Mohseni-Badalabadi R, Moinfar A. Impaired Left Atrial Conduit Function in Coronary Artery Disease Patients With Poorly Controlled Diabetes: Two-Dimensional Speckle-Tracking Echocardiographic Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:13-23. [PMID: 27925659 DOI: 10.7863/ultra.15.12065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/03/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The myocardium can be affected by diabetes mellitus. The effects of blood glucose control on some organs such as the kidney and eye have been previously reported. The aim of our study was to evaluate left atrial function via 2-dimensional (2D) speckle-tracking echocardiography in a group of coronary artery disease (CAD) patients with well-controlled diabetes (hemoglobin A1c [HbA1c] < 7%) and to compare it with that in a group of CAD patients with poorly controlled diabetes. METHODS This cross-sectional study included 110 CAD patients, comprising 44 euglycemic control patients, 33 patients with well-controlled diabetes (HbA1c < 7%), and 33 patients with poorly controlled diabetes. The study population thereafter underwent 2D speckle-tracking echocardiography for an evaluation of their left atrial function. RESULTS Our findings showed that the absolute values of early diastolic strain and early diastolic strain rate were lower in the CAD patients with poorly controlled diabetes than in the euglycemic control patients with CAD. Moreover, early diastolic strain in the CAD patients with poorly controlled diabetes was lower than that in the CAD patients with well-controlled diabetes. Multivariable analysis revealed that poorly controlled diabetes was an independent determinant of early diastolic strain and strain rate. CONCLUSIONS The conduit function of the left atrium was impaired in the CAD patients with poorly controlled diabetes compared with that in the euglycemic control patients with CAD and the CAD patients with well-controlled diabetes.
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Affiliation(s)
- Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran
| | - Reza Mohseni-Badalabadi
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran
| | - Ali Moinfar
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran
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Enomoto M, Ishizu T, Seo Y, Kameda Y, Suzuki H, Shimano H, Kawakami Y, Aonuma K. Myocardial dysfunction identified by three-dimensional speckle tracking echocardiography in type 2 diabetes patients relates to complications of microangiopathy. J Cardiol 2016; 68:282-7. [PMID: 27146366 DOI: 10.1016/j.jjcc.2016.03.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The clinical effect of diabetic microangiopathy on left ventricular (LV) function is still uncertain. The purpose of this study was to assess the relation between diabetic microvascular complications and comprehensive myocardial deformation measurements using three-dimensional (3D) speckle tracking echocardiography. METHODS Seventy-seven asymptomatic patients with type 2 diabetes mellitus (DM) and 35 age-matched healthy control subjects underwent 3D echocardiography. Patients with coronary artery disease or LV ejection fraction <50% were excluded. Presence of proliferative retinopathy, microalbuminuria as nephropathy, and decreased coefficient of variation of R-R intervals (CVRR) <3% as cardiac autonomic neuropathy were defined as diabetic microvascular complications. RESULTS LV ejection fraction, LV mass index, and global radial strain did not differ between control and DM patients. However, global longitudinal and circumferential strain and endocardial area change ratio were lower in patients with DM than in the controls (-12.0±3.0% vs. -16.2±1.9%, -27.7±7.1% vs. 32.2±5.7%, -37.6±7.6% vs. 44.0±6.2%, respectively, p<0.001). In DM patients, longitudinal strain is related to CVRR (R=0.58, p<0.001), retinopathy stage, and nephropathy stage. CONCLUSIONS Diabetic microangiopathy and its accumulated effects significantly related to subclinical LV dysfunction are characterized by impaired longitudinal shortening.
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Affiliation(s)
- Mami Enomoto
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuri Kameda
- Department of Medical Sciences, University of Tsukuba, Tsukuba, Japan
| | - Hiroaki Suzuki
- Division of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Shimano
- Division of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Kawakami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Narimani S, Hosseinsabet A, Pourhosseini H. Effect of Coronary Slow Flow on the Longitudinal Left Ventricular Function Assessed by 2-Dimensional Speckle-Tracking Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:723-729. [PMID: 26939598 DOI: 10.7863/ultra.15.05075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The coronary slow flow phenomenon is defined as the slow progression of an angiographic contrast agent to the distal part of the coronary arteries on selective coronary angiography in the absence of stenosis. There are some studies with different results about the effect of this phenomenon on left ventricular (LV) function. The aim of our study was to evaluate the longitudinal LV function in the coronary slow flow phenomenon using 2-dimensional (2D) speckle-tracking echocardiography. METHODS In a study with a patient-to-patient matched design, 36 patients with the coronary slow flow phenomenon and 36 individuals with normal coronary flow matched for age (±5 years), sex, hypertension, and diabetes mellitus were compared in terms of the longitudinal LV systolic and diastolic functions by pulsed wave tissue Doppler echocardiography and 2D speckle-tracking echocardiography-derived indices. RESULTS Lateral s' and e' waves were lower in the patients with the coronary slow flow phenomenon, but there were no statistically significant differences between the groups regarding the other tissue Doppler echocardiographic indices and longitudinal systolic strain and systolic and diastolic strain rates derived by 2D speckle-tracking echocardiography. CONCLUSIONS Our results showed that the coronary slow flow phenomenon could not impair the longitudinal LV systolic and diastolic functions.
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Affiliation(s)
- Sima Narimani
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hamidreza Pourhosseini
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Kowalik E, Kowalski M, Klisiewicz A, Hoffman P. Global area strain is a sensitive marker of subendocardial damage in adults after optimal repair of aortic coarctation: three-dimensional speckle-tracking echocardiography data. Heart Vessels 2016; 31:1790-1797. [PMID: 26843196 PMCID: PMC5085995 DOI: 10.1007/s00380-016-0803-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/22/2016] [Indexed: 01/20/2023]
Abstract
Aortic coarctation (CoA) in adults is associated with reduced survival. Despite successful repair, some unfavorable changes in the left ventricular (LV) myocardial function are reported. Three-dimensional speckle-tracking imaging (3D-STE) is a novel method that allows to assess regional myocardial function in all directions simultaneously and to calculate global area strain which integrates longitudinal and circumferential deformation. The aim of our study was to assess whether 3-D STE provides any new characteristics of LV deformation in patients with optimal CoA repair. Adults after CoA correction underwent transthoracic echocardiographic examinations. Patients with significant concomitant lesions were ruled out. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were assessed using 3D-STE (Echopac Software, GE). The data were compared with those obtained from healthy subjects. 26 adults (9F/17M; mean age 24.4 years) with repaired CoA were studied. Despite preserved LVEFs, patients with repaired CoA had decreased GAS compared with controls (−28.8 vs. −31.7 %; p = 0.007). No differences between patients and healthy subjects in terms of GLS, GCS and GRS were observed. We found a significant correlation between mean blood pressure and GAS (R = 0.39; p < 0.05). No significant influence of age at repair, CoA correction method or LV mass on three-dimensional deformation was observed. Summarizing, global area strain derived from 3D-STE may be a sensitive indicator of subclinical LV dysfunction in patients after optimal repair of CoA. Mean blood pressure, but not age at correction seems to determine LV deformation.
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Affiliation(s)
- Ewa Kowalik
- Department of Congenital Heart Disease, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Mirosław Kowalski
- Department of Congenital Heart Disease, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - Anna Klisiewicz
- Department of Congenital Heart Disease, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - Piotr Hoffman
- Department of Congenital Heart Disease, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
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Hensel KO, Grimmer F, Roskopf M, Jenke AC, Wirth S, Heusch A. Subclinical Alterations of Cardiac Mechanics Present Early in the Course of Pediatric Type 1 Diabetes Mellitus: A Prospective Blinded Speckle Tracking Stress Echocardiography Study. J Diabetes Res 2016; 2016:2583747. [PMID: 26839891 PMCID: PMC4709644 DOI: 10.1155/2016/2583747] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/21/2015] [Accepted: 10/27/2015] [Indexed: 01/14/2023] Open
Abstract
Diabetic cardiomyopathy substantially accounts for mortality in diabetes mellitus. The pathophysiological mechanism underlying diabetes-associated nonischemic heart failure is poorly understood and clinical data on myocardial mechanics in early stages of diabetes are lacking. In this study we utilize speckle tracking echocardiography combined with physical stress testing in order to evaluate whether left ventricular (LV) myocardial performance is altered early in the course of uncomplicated type 1 diabetes mellitus (T1DM). 40 consecutive asymptomatic normotensive children and adolescents with T1DM (mean age 11.5 ± 3.1 years and mean disease duration 4.3 ± 3.5 years) and 44 age- and gender-matched healthy controls were assessed using conventional and quantitative echocardiography (strain and strain rate) during bicycle ergometer stress testing. Strikingly, T1DM patients had increased LV longitudinal (p = 0.019) and circumferential (p = 0.016) strain rate both at rest and during exercise (p = 0.021). This was more pronounced in T1DM patients with a longer disease duration (p = 0.038). T1DM patients with serum HbA1c > 9% showed impaired longitudinal (p = 0.008) and circumferential strain (p = 0.005) and a reduced E/A-ratio (p = 0.018). In conclusion, asymptomatic T1DM patients have signs of hyperdynamic LV contractility early in the course of the disease. Moreover, poor glycemic control is associated with early subclinical LV systolic and diastolic impairment.
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Affiliation(s)
- Kai O. Hensel
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
- *Kai O. Hensel:
| | - Franziska Grimmer
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Markus Roskopf
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Andreas C. Jenke
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Stefan Wirth
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Andreas Heusch
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
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Ma H, Xie RA, Gao LJ, Zhang JP, Wu WC, Wang H. Prediction of Left Ventricular Filling Pressure by 3-Dimensional Speckle-Tracking Echocardiography in Patients With Coronary Artery Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1809-1818. [PMID: 26333567 DOI: 10.7863/ultra.15.14.11010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/12/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the diagnostic value of 3-dimensional (3D) speckle-tracking echocardiography for estimating left ventricular filling pressure in patients with coronary artery disease (CAD) and a preserved left ventricular ejection fraction. METHODS Altogether, 84 patients with CAD and 30 age- and sex-matched healthy control participants in sinus rhythm were recruited prospectively. All participants underwent conventional and 3D speckle-tracking echocardiography. Global strain values were automatically calculated by 3D speckle-tracking analysis. The left ventricular end-diastolic pressure (LVEDP) was determined invasively by left heart catheterization. Echocardiography and cardiac catheterization were performed within 24 hours. RESULTS Compared with the controls, patients with CAD showed lower global longitudinal strain, global circumferential strain, global area strain, and global radial strain. Patients with CAD who had an elevated LVEDP had much lower levels of all 4 3D-speckle-tracking echocardiographic variables. Pearson correlation analysis revealed that the LVEDP correlated positively with the early transmitral flow velocity/early diastolic myocardial velocity (E/E') ratio, global longitudinal strain, global circumferential strain, and global area strain. It correlated negatively with global radial strain. Receiver operating characteristic curve analysis revealed that these 3D speckle-tracking echocardiographic indices could effectively predict elevated left ventricular filling pressure (LVEDP >15 mm Hg) in patients with CAD (areas under the curve: global longitudinal strain, 0.78; global radial strain, 0.77; global circumferential strain, 0.75; and global area strain, 0.74). These parameters, however, showed no advantages over the commonly used E/E' ratio (area under the curve, 0.84). CONCLUSIONS Three-dimensional speckle-tracking echocardiography was a practical technique for predicting elevated left ventricular filling pressure, but it might not be superior to the commonly used E/E' ratio in patients with CAD who have a normal left ventricular ejection fraction.
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Affiliation(s)
- Hong Ma
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.)
| | - Rong-Ai Xie
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.)
| | - Li-Jian Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.)
| | - Jin-Ping Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.)
| | - Wei-Chun Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.).
| | - Hao Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.).
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Wang Q, Gao Y, Tan K, Xia H, Li P. Assessment of left ventricular function by three-dimensional speckle-tracking echocardiography in well-treated type 2 diabetes patients with or without hypertension. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:502-511. [PMID: 25801852 DOI: 10.1002/jcu.22268] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 01/19/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE The aims of this study were to investigate the myocardial deformation in well-treated type 2 diabetes patients with or without hypertension using three-dimensional speckle-tracking echocardiography and to explore variables that could affect myocardial deformation. METHODS We studied 82 patients with type 2 diabetes and controlled blood glucose, including 46 subjects with diabetes alone and 36 subjects with diabetes and well-controlled hypertension, and 40 age- and gender-matched controls. Left ventricular real-time three-dimensional (3D) full-volume images were recorded and analyzed using online software. The left ventricular ejection fraction, global longitudinal strain (GLS), global circumferential strain, global area strain, and global radial strain were measured and compared. RESULTS Despite a similar three-dimensional left ventricular ejection fraction, GLS was significantly lower in patients with diabetes only than in controls (p < 0.001). Patients with diabetes and hypertension showed significantly lower systolic strains in all directions than controls and patients with diabetes only (p < 0.001 and p < 0.05, respectively). Multiple regression analysis revealed that fasting plasma glucose and left ventricular end-diastolic volume were significant factors influencing GLS in both diabetic groups. CONCLUSIONS Early-stage diabetic patients showed an impaired left ventricular strain that was worsened by coexistent hypertension, although blood glucose and blood pressure were well controlled. Three-dimensional speckle-tracking echocardiography was able to detect these subclinical changes.
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Affiliation(s)
- Qingqing Wang
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Yunhua Gao
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Kaibin Tan
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Hongmei Xia
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Peijing Li
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
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Evaluation of myocardial infarction size with three-dimensional speckle tracking echocardiography: a comparison with single photon emission computed tomography. Int J Cardiovasc Imaging 2015; 31:1571-81. [DOI: 10.1007/s10554-015-0745-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/13/2015] [Indexed: 12/17/2022]
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Opdahl A, Helle-Valle T, Skulstad H, Smiseth OA. Strain, Strain Rate, Torsion, and Twist: Echocardiographic Evaluation. Curr Cardiol Rep 2015; 17:568. [DOI: 10.1007/s11886-015-0568-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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50
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Wang Q, Gao Y, Tan K, Li P. Subclinical impairment of left ventricular function in diabetic patients with or without obesity: A study based on three-dimensional speckle tracking echocardiography. Herz 2014; 40 Suppl 3:260-8. [PMID: 25491664 DOI: 10.1007/s00059-014-4186-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/12/2014] [Accepted: 11/04/2014] [Indexed: 01/15/2023]
Abstract
AIMS The aim of this study was to investigate subclinical left ventricular (LV) changes between type 2 diabetic patients with or without obesity using three-dimensional speckle-tracking echocardiography (3DSTE). METHODS A total of 77 type 2 diabetic patients, including 36 subjects with BMI < 25 kg/m(2) and 41 subjects with BMI ≥ 25 kg/m(2), as well as 40 age- and sex-matched controls (BMI: 18.5 ~ 24.5 kg/m(2)) were studied. Waist circumference was measured in diabetic patients with a BMI ≥ 25 kg/m(2) to determine whether abdominal obesity as a complication was present. Real-time three-dimensional (3D) full volume images of the left ventricle were recorded and analyzed. Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were calculated and compared. RESULTS Compared with the controls, diabetic subjects without overall obesity had significantly lower GCS, GAS, and GRS (p < 0.05), as well as markedly lower GLS (p < 0.001). However, 3D-LVEF and all global strains in diabetic subjects with overall obesity were not only markedly lower compared with controls (p < 0.002 and p < 0.001), but also significantly lower than those in diabetic subjects without overall obesity (p < 0.002 and p < 0.05). HbA1c and BMI showed negative impacts on all strains in diabetic patients. Meanwhile, the diabetic subjects with overall and abdominal obesity had significantly reduced GLS, GCS, GAS, and GRS compared with those with overall obesity only (all p < 0.05). CONCLUSIONS Type 2 diabetic patients demonstrated early-stage subclinical LV deformation and dysfunction, whilst coexistent obesity resulted in further damage to myocardial contractility and reduced LVEF. 3DSTE was a sensitive method for detecting these abnormalities.
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Affiliation(s)
- Q Wang
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, No. 183 Xinqiao Street, Chongqing, China
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