title: Changes in multidirectional LV strain in asymptomatic patients with type 2 diabetes mellitus: a 2-year follow-up study.
abstract: OBJECTIVE
  Asymptomatic patients with diabetes mellitus (DM) and normal left ventricular (LV) ejection fraction (EF) may have LV dysfunction as assessed with speckle tracking echocardiography. Whether this subtle LV dysfunction may progress or not over time remains unknown. The present evaluation assessed changes in LV function with two-dimensional (2D) speckle tracking analysis in asymptomatic clinically stable patients with type 2 DM and normal LVEF after 2-year follow-up.
  
  
  RESULTS
  A total of 112 asymptomatic patients with type 2 DM and normal LVEF (53 ± 10 years, 59% men) were evaluated. Patients remained clinically stable between baseline and follow-up echocardiography. Conventional and 2D speckle tracking echocardiographic measurements were performed. Circumferential strain (CS) and longitudinal strain (LS) were measured to assess systolic function and strain rate during isovolumetric relaxation time (SR IVR) and peak transmitral early diastolic inflow strain rate (SR E) to assess diastolic function. After 2-year follow-up, a significant increase in the LV mass index and significant decrease in the E/A ratio were observed. Left ventricular ejection fraction remained unchanged (59 to 60%, P = 0.4). In contrast, 2D speckle tracking analysis demonstrated a significant impairment in CS (-19.7 ± 4.0 to -18.9 ± 3.8%, P < 0.001), LS (-17.2 ± 2.3 to -16.9 ± 2.7%, P = 0.022), and SR E (from 1.02 ± 0.28 to 0.94 ± 0.25 S(-1), P < 0.001). After adjusting for changes in the LV mass index, only changes in CS and SR E remained significant (P < 0.001 and P = 0.013, respectively).
  
  
  CONCLUSIONS
  Asymptomatic patients with type 2 DM and normal LVEF may show mild progression of subclinical LV function assessed with 2D speckle tracking echocardiography. The prognostic implications of these mild changes warrant prospective evaluation.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Postbus 9600, Leiden 2300 RC, the Netherlands.
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: Roos
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Scholte
authors.forename: Aantje V
authors.initials: AV
authors.lastname: Kharagjitsingh
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: 2D Speckle tracking echocardiography; Diabetes mellitus; Left ventricular diastolic function; Left ventricular function