Vol 13, No 5 (2024)
Research paper
Published online: 2024-08-30

open access

Page views 118
Article views/downloads 66
Get Citation

Connect on Social Media

Connect on Social Media

Cut-Off Point Value to Evaluate Abnormality of Systolic Deformation Parameters in Patients with Type 2 Diabetes

Nguyen Trang Nguyen12, Anh Vu Nguyen1, Van Chi Le1, Hoang Thuy Linh Nguyen3, Hoa Thi Phu4, Anh Tien Hoang1
DOI: 10.5603/cd.100784
Clin Diabetol 2024;13(5):291-298.

Abstract

Objective: The goal of this study is to determine the cut-off value that can be used to evaluate systolic deformation parameters and the prevalence of abnormalities in left ventricular function in patients with type 2 diabetes (T2D). Materials and methods: The study used a cross-sectional descriptive method. The study’s sample size was 311 people (including 192 subjects with T2D and 119 subjects as the controls). The subjects who participated had to meet both the exclusion criteria and inclusion criteria. Besides clinical examinations, they underwent an echocardiography and laboratory tests. Statistical analyses included frequency, mean, unpaired t-test or Mann-Whitney U test, and receiver operating characteristic curve. Results: The average age of the T2D group was 66.5 ± 10.2 years, and the control group were aged 64.7 ± 6.0 years; the groups comprised 37% men and 63% women. The cut-off value to evaluate the abnormality of global longitudinal strain (GLS) was –19%, the global longitudinal strain rate (GLSR) was –1.9 1/s, the global circumferential strain (GCS) was  27.4%, the global circumferential strain rate (GCSR) was –3.2 1/s, and the longitudinal — circumferential index was  22.4%. The proportion of T2D patients with abnormal GLS was 78.6%, GLSR was 65.1%, GCS was 45.8%, GCSR was 60.9%, and longitudinal-circumferential index was 50%. Conclusions: Speckle tracking echocardiography was more sensitive in identifying subclinical myocardial dysfunction than conventional echocardiography. A large proportion of patients with T2D had abnormal left ventricular systolic deformation, even though the ejection fraction was still normal.

Article available in PDF format

View PDF Download PDF file

References

  1. International Diabetes Federation, IDF Diabetes Atlas. 2021. https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf (18.05.2024).
  2. ElSayed NA, Aleppo G, Aroda VR, et al. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2023. Diabetes Care. 2023; 46(Suppl 1): S158–S190.
  3. Nichols GA, Hillier TA, Erbey JR, et al. Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors. Diabetes Care. 2001; 24(9): 1614–1619.
  4. Dunlay SM, Givertz MM, Aguilar D, et al. American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and the Heart Failure Society of America. Type 2 Diabetes Mellitus and Heart Failure: A Scientific Statement From the American Heart Association and the Heart Failure Society of America: This statement does not represent an update of the 2017 ACC/AHA/HFSA heart failure guideline update. Circulation. 2019; 140(7): e294–e324.
  5. Cavender MA, Steg PhG, Smith SC, et al. REACH Registry Investigators. Impact of Diabetes Mellitus on Hospitalization for Heart Failure, Cardiovascular Events, and Death: Outcomes at 4 Years From the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Circulation. 2015; 132(10): 923–931.
  6. Cosentino F, Grant PJ, Aboyans V, et al. ESC Scientific Document Group. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020; 41(2): 255–323.
  7. Wu H, Norton V, Cui K, et al. Diabetes and Its Cardiovascular Complications: Comprehensive Network and Systematic Analyses. Front Cardiovasc Med. 2022; 9: 841928.
  8. Boonman-de Winter LJM, Rutten FH, Cramer MJM, et al. High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes. Diabetologia. 2012; 55(8): 2154–2162.
  9. Conti CR. Assessing ventricular function. Clin Cardiol. 2000; 23(8): 557–558.
  10. Wright L, Bogaert J. CMR - Basic rinciles, In: Wright L, Bogaert J. ed. The ESC Textbook of Cardiovascular Imaging. Oxford University Press, Oxford 2015: 55–63.
  11. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14.
  12. Marwick T, Kosmala W. Strain imaging applications and techniques. ASE's Comprehensive Strain Imaging. 2022: 1–19.
  13. Ng ACT, Delgado V, Bertini M, et al. Findings from left ventricular strain and strain rate imaging in asymptomatic patients with type 2 diabetes mellitus. Am J Cardiol. 2009; 104(10): 1398–1401.
  14. Park JJ, Park JB, Park JH, et al. Global Longitudinal Strain to Predict Mortality in Patients With Acute Heart Failure. J Am Coll Cardiol. 2018; 71(18): 1947–1957.
  15. Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging. 2009; 2(5): 356–364.
  16. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: . Diabetes Care. 2020; 43(Suppl 1): S14–S31.
  17. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403): 157–163.
  18. Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019; 32(1): 1–64.
  19. Nagueh SF, Smiseth OA, Appleton CP, et al. Houston, Texas; Oslo, Norway; Phoenix, Arizona; Nashville, Tennessee; Hamilton, Ontario, Canada; Uppsala, Sweden; Ghent and Liège, Belgium; Cleveland, Ohio; Novara, Italy; Rochester, Minnesota; Bucharest, Romania; and St. Louis, Missouri. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016; 17(12): 1321–1360.
  20. Nguyen NT, Nguyen AV, Le VC. The Association between Left Ventricular Myocardial Strains and Risk Factors of Cardiovascular Disease in a Population with Type 2 Diabetes Mellitus: A Primary Controlled Cross-Sectional Study. Journal of Medicinal and Chemical Sciences. 2023; 7(1): 166–175.
  21. Hatani Y, Tanaka H, Mochizuki Y, et al. Association of body fat mass with left ventricular longitudinal myocardial systolic function in type 2 diabetes mellitus. J Cardiol. 2020; 75(2): 189–195.
  22. Nakai H, Takeuchi M, Nishikage T, et al. Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration. Eur J Echocardiogr. 2009; 10(8): 926–932.
  23. Ng ACT, Bertini M, Ewe SH, et al. Defining Subclinical Myocardial Dysfunction and Implications for Patients With Diabetes Mellitus and Preserved Ejection Fraction. Am J Cardiol. 2019; 124(6): 892–898.
  24. Yamauchi Y, Tanaka H, Yokota S, et al. Effect of heart rate on left ventricular longitudinal myocardial function in type 2 diabetes mellitus. Cardiovasc Diabetol. 2021; 20(1): 87.
  25. Grundy SM, Benjamin IJ, Burke GL, et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation. 1999; 100(10): 1134–1146.
  26. Kasznicki J, Drzewoski J. Heart failure in the diabetic population - pathophysiology, diagnosis and management. Arch Med Sci. 2014; 10(3): 546–556.
  27. Li Z, Han D, Qi T, et al. Hemoglobin A1c in type 2 diabetes mellitus patients with preserved ejection fraction is an independent predictor of left ventricular myocardial deformation and tissue abnormalities. BMC Cardiovasc Disord. 2023; 23(1): 49.
  28. Halabi A, Potter E, Yang H, et al. Association of biomarkers and risk scores with subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus. Cardiovasc Diabetol. 2022; 21(1): 278.
  29. Li W, Li Z, Liu W, et al. Two-dimensional speckle tracking echocardiography in assessing the subclinical myocardial dysfunction in patients with gestational diabetes mellitus. Cardiovasc Ultrasound. 2022; 20(1): 21.
  30. Liu J, Yang F, Sun Q, et al. Fat Mass is Associated with Subclinical Left Ventricular Systolic Dysfunction in Patients with Type 2 Diabetes Mellitus Without Established Cardiovascular Diseases. Diabetes Ther. 2023; 14(6): 1037–1055.