Giacomo Zoppini1, Corinna Bergamini2, Stefano Bonapace3, Andrea Rossi2, Maddalena Trombetta4, Alessandro Mantovani4, Anna Toffalini4, Laura Lanzoni3, Lorenzo Bertolini5, Luciano Zenari5, Enzo Bonora4, Giovanni Targher4. 1. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy. Electronic address: giacomo.zoppini@univr.it. 2. Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. 3. Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy. 4. Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy. 5. Division of General Medicine and Diabetes Unit, "Sacro Cuore" Hospital, Negrar (VR), Italy.
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.
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 diabeticpatients 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 diabeticpatients 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.
Authors: Giacomo Zoppini; Corinna Bergamini; Stefano Bonapace; Maddalena Trombetta; Alessandro Mantovani; Anna Toffalini; Laura Lanzoni; Lorenzo Bertolini; Luciano Zenari; Enzo Bonora; Giovanni Targher; Andrea Rossi Journal: BMJ Open Diabetes Res Care Date: 2018-06-14