Silent diabetic cardiomyopathy in everyday practice: a clinical and echocardiographic study

Brane Loncarevic; Danijela Trifunovic; Ivan Soldatovic; Bosiljka Vujisic-Tesic

doi:10.1186/s12872-016-0395-z

Silent diabetic cardiomyopathy in everyday practice: a clinical and echocardiographic study

BMC Cardiovasc Disord. 2016 Nov 29;16(1):242. doi: 10.1186/s12872-016-0395-z.

Authors

Brane Loncarevic¹, Danijela Trifunovic^{2

3}, Ivan Soldatovic^{4

5}, Bosiljka Vujisic-Tesic^{6

4}

Affiliations

¹ Outpatient Cardiology Clinic "Corona", Uzice, Serbia.
² Cardiology, University Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia. danijelatrif@gmail.com.
³ School of Medicine, University of Belgrade, Belgrade, Serbia. danijelatrif@gmail.com.
⁴ School of Medicine, University of Belgrade, Belgrade, Serbia.
⁵ Institute for Biostatistics, School of Medicine, University of Belgrade, Belgrade, Serbia.
⁶ Cardiology, University Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.

Abstract

Background: Whether type 2 diabetes mellitus (DM) in the absence of hypertension (HTA) and coronary artery disease (CAD) affects left ventricular (LV) phenotype and function among asymptomatic DM patients that can be easily discovered in everyday practice, what is the clinical risk profile for diabetic cardiomyopathy and how HTA and CAD modulate LV structure and function above diabetic cardiomyopathy, are still incompletely answered questions.

Methods: In 210 DM patients (group I: 70 asymptomatic DM patients without HTA and CAD; group II: 70 DM patients with HTA and no CAD; group III: 70 DM patients with CAD and no HTA) and 80 healthy individuals, comprehensive echocardiography including speckle tracking strain and strain rate analysis, was done.

Results: Compared to control DM patients without HTA and CAD had increased LV mass, more frequently concentric remodeling, impaired LV relaxation and lower LV ejection fraction (EF), fraction of shortening (FS) and mitral annular plane excursion (MAPSE). Addition of HTA further impaired EF, FS and MAPSE and aggravated diastolic dysfunction, whereas concomitant CAD further impaired FS and MAPSE. Peak global longitudinal strain (S_long) and early diastolic longitudinal strain rate (SR_long E) were impaired in group I compared to control, even when EF was preserved. Peak circumferential strain (S_circ) was impaired only when DM was associated with HTA or CAD. In multivariate analysis DM was significantly and independently from HTA, CAD, age, gender and body mass index associated with: increased LV mass, concentric LV remodeling, lower EF, FS, MAPSE, S_long, SR_longE and distorted diastolic parameters. DM duration, glycosylated hemoglobin, microalbuminuria and retinopathy, were not independent predictors of LV geometry and function.

Conclusion: DM per se has strong and independent influence on LV phenotype and function that can be detected by conventional and speckle tracking echocardiography in everyday clinical practice, even in asymptomatic patients. We could not confirm that these changes were independently related to duration of DM, quality of metabolic control and presence of microvascular complications. Concomitant HTA or CAD furthermore distorted LV systolic and diastolic function.

Keywords: Coronary artery disease; Diabetic cardiomyopathy; Hypertension; Obesity; Speckle tracking echocardiography.

MeSH terms

Asymptomatic Diseases
Diabetic Cardiomyopathies / diagnosis*
Diabetic Cardiomyopathies / epidemiology
Diabetic Cardiomyopathies / physiopathology
Diastole
Echocardiography / methods*
Female
Follow-Up Studies
Heart Ventricles / diagnostic imaging*
Heart Ventricles / physiopathology
Humans
Male
Middle Aged
Reproducibility of Results
Risk Factors
Serbia / epidemiology
Stroke Volume / physiology*
Systole
Ventricular Function, Left / physiology*
Ventricular Remodeling / physiology*