title: Longitudinal myocardial strain alteration is associated with left ventricular remodeling in asymptomatic patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  In normal subjects, left ventricular (LV) dimensions have been shown to decrease over time, while wall thickness is increasing. The aim of this study was to investigate LV remodeling in a cohort of patients with type 2 diabetes mellitus during a 3-year follow-up period and its potential association with decreased longitudinal systolic strain (εL).
  
  
  METHODS
  One hundred seventy-two patients with type 2 diabetes without overt heart disease were prospectively enrolled and underwent echocardiography with speckle-tracking imaging to assess global LV εL at baseline and at 3 years. The associations between alteration in εL (defined as |εL| < 18%), LV geometry at baseline, and LV remodeling over time were evaluated.
  
  
  RESULTS
  Among the 172 enrolled patients, 154 completed 3-year follow-up. At baseline, patients with εL alteration had higher LV end-systolic volumes (28 ± 11 vs 23 ± 9 mL, P < .001) and relative wall thicknesses (RWT; 0.44 ± 0.06 vs 0.40 ± 0.07, P = .008) compared with those with normal εL. At 3-year follow-up, RWTs remained stable in both groups. LV volumes significantly decreased in patients with normal εL but not in patients with εL alteration. Multivariate analysis showed that εL alteration was independently associated with LV end-systolic volume (β = 5.0, P = .006) and RWT (β = 0.03, P = .03) at baseline and with changes in both LV end-diastolic volume (β = 19.1, P = .001) and LV end-systolic volume (β = 2.6, P = .047) over 3 years.
  
  
  CONCLUSIONS
  In patients with type 2 diabetes, εL alteration was associated with higher RWT and LV volumes and with the absence of decreases in LV volumes over time, which might be an early sign of adverse LV remodeling.
authors: Service des Explorations Fonctionnelles Cardiovasculaires & Centre d'Investigation Clinique, Louis Pradel Hospital, Lyon, France; INSERM U955, Team 8, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, Créteil, France.
authors: Laura
authors: L
authors: Ernande
authors: Service des Explorations Fonctionnelles Cardiovasculaires & Centre d'Investigation Clinique, Louis Pradel Hospital, Lyon, France.
authors: Cyrille
authors: C
authors: Bergerot
authors: INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.
authors: Nicolas
authors: N
authors: Girerd
authors: Service des Explorations Fonctionnelles Cardiovasculaires & Centre d'Investigation Clinique, Louis Pradel Hospital, Lyon, France; CarMeN INSERM Unit 1060, Claude Bernard Lyon 1 University, Lyon, France.
authors: Hélène
authors: H
authors: Thibault
authors: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors: Einar Skulstad
authors: ES
authors: Davidsen
authors: Service des Explorations Fonctionnelles Cardiovasculaires & Centre d'Investigation Clinique, Louis Pradel Hospital, Lyon, France.
authors: Pierre
authors: P
authors: Gautier Pignon-Blanc
authors: Service des Explorations Fonctionnelles Cardiovasculaires & Centre d'Investigation Clinique, Louis Pradel Hospital, Lyon, France.
authors: Camille
authors: C
authors: Amaz
authors: CREATIS, UMR CNRS 5220, INSERM U1044, Université Jean Monnet Saint-Etienne, CHU Saint-Etienne, Université de Lyon, Lyon, France.
authors: Pierre
authors: P
authors: Croisille
authors: Department of Cardiology, Ghent University, Ghent, Belgium.
authors: Marc L
authors: ML
authors: De Buyzere
authors: Department of Cardiology, Ghent University, Ghent, Belgium.
authors: Ernst R
authors: ER
authors: Rietzschel
authors: Department of Cardiology, Ghent University, Ghent, Belgium.
authors: Thierry C
authors: TC
authors: Gillebert
authors: CarMeN INSERM Unit 1060, Claude Bernard Lyon 1 University, Lyon, France; Department of Endocrinology, Louis Pradel Hospital, Lyon, France.
authors: Philippe
authors: P
authors: Moulin
authors: INSERM U955, Team 8, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, Créteil, France.
authors: Mikhael
authors: M
authors: Altman
authors: Service des Explorations Fonctionnelles Cardiovasculaires & Centre d'Investigation Clinique, Louis Pradel Hospital, Lyon, France; INSERM U955, Team 8, Faculté de Médecine de Créteil, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, Créteil, France. Electronic address: gderumeaux@gmail.com.
authors: Geneviève
authors: G
authors: Derumeaux
mesh_terms: D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D033081:Shear Strength; D013314:Stress, Mechanical; D013318:Stroke Volume; D013718:Tensile Strength; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D020257:Ventricular Remodeling
keywords: Diabetes mellitus; Left ventricular remodeling; Myocardial strain