title: Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration.
abstract: OBJECTIVE
  Early detection of diabetic heart disease is important for the timely interventions resulting in the prevention for the future development of heart failure. Subclinical left ventricular (LV) systolic dysfunction may be identified by a reduction in longitudinal function, which can be assessed using 2D speckle tracking echocardiography (STE).
  
  
  RESULTS
  To determine longitudinal, radial, and circumferential function, three LV short-axis and three LV apical views were acquired in 60 asymptomatic diabetic patients with normal LV ejection fraction (EF) and 25 age-matched healthy volunteers. Using 2D strain software, end-systolic longitudinal strain (LS), radial strain (RS), and circumferential strain (CS) were measured in 18 LV segments. No significant differences in LVEF were noted between two groups. Diabetic patients had more advanced diastolic dysfunction and increased LV mass compared with normal subjects. Basal, middle, and apical LSs were significantly lower in diabetic patients compared with control subjects, with 43% (26/60) of the diabetic patients showing abnormal global LS values (cut-off value: -17.2, mean - 2SD in control subjects). Basal RS and apical CS were also significantly lower in diabetic patients. Multivariate linear regression analysis showed that diabetic duration was the only independent confounder for the reduction of LS (t = 2.22, P = 0.0313).
  
  
  CONCLUSIONS
  In addition to diastolic dysfunction, subclinical LV longitudinal dysfunction is preferentially and frequently observed in asymptomatic diabetes patients with normal LVEF. The decrease in LS correlated with duration of diabetes. 2DSTE has the potential for detecting subclinical LV systolic dysfunction and might provide useful information of the risk stratification in an asymptomatic diabetic population.
authors.affiliation: Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Nakai
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nishikage
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Otsuji
mesh_terms: D016022:Case-Control Studies; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology