title: Combined circumferential and longitudinal left ventricular systolic dysfunction in patients with type 2 diabetes mellitus without myocardial ischemia.
abstract: OBJECTIVE
  Left ventricular (LV) circumferential or longitudinal shortening may be impaired in patients with type 2 diabetes mellitus (DM). In the present study, patients with type 2 DM without myocardial ischemia and combined impairment of circumferential and longitudinal (C+L) shortening were studied to assess the prevalence and factors associated with this condition.
  
  
  METHODS
  Data from 386 patients with type 2 DM enrolled in the SHORTening of midWall and longitudinAl left Ventricular fibers in diabEtes study were analyzed. One hundred twenty healthy subjects were used to define C+L dysfunction. Stress-corrected midwall shortening and mitral annular peak systolic velocity were considered as indexes of C+L shortening and classified as low if <89% and <8.5 cm/s, respectively (10th percentiles of controls).
  
  
  RESULTS
  Combined C+L dysfunction was detected in 66 patients (17%). The variables associated with this condition were lower glomerular filtration rate (OR 0.98 [95% CI 0.96 to 0.99], greater LV mass (OR 1.05 [95% CI 1.02 to 1.08]), high pulmonary artery wedge pressure (OR 1.23 [95% CI 1.04 to 1.44]) and mitral annular calcifications (OR 3.35 [95% CI 1.71 to 6.55]). Considering the entire population, the relationship between stress-corrected midwall shortening and peak systolic velocity was poor (r=0.20), and the model was linear. The relationship was considerably closer and nonlinear in patients with combined C+L dysfunction (r=0.61; P<0.001), having the best fit by cubic function.
  
  
  CONCLUSIONS
  Combined C+L dysfunction was present in one-sixth of patients with type 2 DM without myocardial ischemia. This condition was associated with reduced renal function, worse hemodynamic status and structural LV abnormalities, and may be considered a preclinical risk factor for heart failure.
authors.affiliation: Department of Cardiology, Villa Bianca Hospital, Trento;
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Faganello
authors.forename: Stefania
authors.initials: S
authors.lastname: De Feo
authors.forename: Nicola
authors.initials: N
authors.lastname: Berlinghieri
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.forename: Riccardo
authors.initials: R
authors.lastname: Candido
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
keywords: Diabetes; Left ventricular systolic dysfunction; Longitudinal function; Midwall shortening; Mitral calcification