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Subclinical impairment of left ventricular function in diabetic patients with or without obesity

A study based on three-dimensional speckle tracking echocardiography

Subklinische Beeinträchtigung der linksventrikulären Funktion bei Diabetespatienten mit oder ohne Adipositas

Eine Studie auf der Grundlage der 3-D-Speckle-Tracking-Echokardiographie

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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/m2 and 41 subjects with BMI ≥ 25 kg/m2, as well as 40 age- and sex-matched controls (BMI: 18.5 ~ 24.5 kg/m2) were studied. Waist circumference was measured in diabetic patients with a BMI ≥ 25 kg/m2 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.

Zusammenfassung

Ziel

Ziel der Studie war es, subklinische linksventrikuläre (LV) Veränderungen bei Typ-2-Diabetes-Patienten mit oder ohne Adipositas unter Einsatz der dreidimensionalen Speckle-Tracking-Echokardiographie (3DSTE) zu untersuchen.

Methoden

Es wurden 77 Typ-2-Diabetes-Patienten, darunter 36 Teilnehmer mit einem Body-Mass-Index (BMI) < 25 kg/m2 und 41 Teilnehmer mit einem BMI ≥ 25 kg/m2, sowie 40 in Alter und Geschlecht entsprechende Kontrollen (BMI: 18,5 ~ 24,5 kg/m2) untersucht. Ob bei den Diabetespatienten mit einem BMI ≥ 25 kg/m2 die Komplikation einer abdominellen Adipositas vorlag, hing vom Taillenumfang ab. Ein 3-D-Echtzeit-full-Volume-Datensatz des linken Ventrikels wurde dokumentiert und analysiert. Die linksventrikuläre Ejektionsfraktion (LVEF), globale longitudinale Deformation („global longitudinal strain“, GLS), globale zirkumferenzielle Deformation („global circumferential strain“, GCS), globale flächige Deformation („global area strain“, GAS) und globale radiale Deformation („global radial strain“, GRS) wurden berechnet und verglichen.

Ergebnisse

Verglichen mit den Kontrollen wiesen Diabetespatienten ohne allgemeine Adipositas eine signifikant niedrigere GCS, GAS und GRS (p < 0,05) sowie eine deutlich niedrigere GLS auf (p < 0,001). Jedoch waren die 3D-LVEF und alle globalen Deformationen bei Diabetespatienten mit allgemeiner Adipositas nicht nur deutlich niedriger als bei den Kontrollen (p < 0,002 bzw. p < 0,001), sondern auch signifikant niedriger als bei den Diabetespatienten ohne allgemeine Adipositas (p < 0,002 bzw. p < 0,05). Der HbA1c-Wert und der BMI hatten negative Auswirkungen auf alle Deformationen bei Diabetespatienten. Bei den Diabetespatienten mit allgemeiner und abdomineller Adipositas waren GLS, GCS, GAS und GRS im Vergleich zu den Werten bei allgemeiner Adipositas allein signifikant vermindert (alle p < 0,05).

Schlussfolgerung

Die Typ-2-Diabetes-Patienten wiesen eine subklinische LV-Verformung und -Funktionsstörung im frühen Stadium auf, und eine begleitende Adipositas führte zu einer weiteren Schädigung der Myokardkontraktilität sowie zu einer verminderten LVEF. Die 3DSTE stellte sich als sensitives Verfahren zur Erkennung dieser Auffälligkeiten heraus.

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Compliance with ethical guidelines

Conflict of interest. Q. Wang, Y. Gao, K. Tan, and P. Li state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

Consent was obtained from all patients identifiable from images or other information within the manuscript. In the case of underage patients, consent was obtained from a parent or legal guardian.

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Authors and Affiliations

  1. Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, No. 183 Xinqiao Street, Chongqing, China

    Q. Wang, Y. Gao, K. Tan & P. Li

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  1. Q. Wang
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  2. Y. Gao
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Correspondence to Y. Gao.

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Wang, Q., Gao, Y., Tan, K. et al. Subclinical impairment of left ventricular function in diabetic patients with or without obesity. Herz 40 (Suppl 3), 260–268 (2015). https://doi.org/10.1007/s00059-014-4186-y

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  • DOI: https://doi.org/10.1007/s00059-014-4186-y

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