title: The worrisome liaison between left ventricular systolic dysfunction and mitral annulus calcification in type 2 diabetes without coronary artery disease: data from the SHORTWAVE study.
abstract: OBJECTIVE
  Mitral annulus calcification (MAC) is a marker for coronary artery disease (CAD) and predicts poor outcome in the general population. No data are available on MAC in patients with type 2 diabetes. In these patients we assessed prevalence of MAC and the relation between MAC and left ventricular (LV) systolic function.
  
  
  RESULTS
  As many as 386 patients with type 2 diabetes without CAD were studied with Doppler echocardiography. LV systolic dysfunction was defined by analyzing 120 healthy subjects. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (peak S') were considered as indexes of LV circumferential and longitudinal shortening and classified low if <89% and <8.5 cm/s, respectively (10th percentiles of controls). Patients who had MAC (107 = 28%) were older with longer duration of DM and were receiving more anti-hypertension medications than those who had not. At echocardiographic evaluation patients with MAC showed higher LV mass, larger left atrial volume (LAV), reduced sc-MS (88.4 ± 14.9 vs 92.6 ± 14.3%; p = 0.01) and peak S' (8.9 ± 2.2 vs 10.0 ± 2.0 cm/s; p < 0.001) than patients without MAC. Multiple logistic regression demonstrated older age (OR 1.03 [IC 1.01-1.06], p = 0.009), larger LAV (OR 1.19 [IC 1.11-1.28], p < 0.001) and combined reduction in sc-MS and peak S' (OR 3.00 [IC 1.57-5.72], p = 0.001) as independent factors associated with MAC.
  
  
  CONCLUSIONS
  MAC is detectable in one fourth of patients with type 2 diabetes without CAD and is mostly related to LV systolic dysfunction expressed as combined impairment of LV circumferential and longitudinal fibers, independent of age and LAV.
authors.affiliation: Cardiovascular Center, Azienda per i Servizi Sanitari n° 1, Trieste, Italy. Electronic address: giorgio.faganello@libero.it.
authors.forename: G
authors.initials: G
authors.lastname: Faganello
authors.forename: P
authors.initials: P
authors.lastname: Faggiano
authors.forename: R
authors.initials: R
authors.lastname: Candido
authors.forename: L
authors.initials: L
authors.lastname: Tarantini
authors.forename: A
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: S
authors.initials: S
authors.lastname: De Feo
authors.forename: G
authors.initials: G
authors.lastname: Cioffi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D003324:Coronary Artery Disease; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000000981:diagnostic imaging*; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Cardiac function; Diabetes mellitus; Left atrial volume; Left ventricular systolic dysfunction; Mitral calcification