title: Subclinical left ventricular systolic dysfunction in diabetic patients and its association with retinopathy: A 2D speckle tracking echocardiography study.
abstract: OBJECTIVE
  It is important to diagnose diabetic cardiomyopathy in the early stages to prevent development of evident heart failure in the future. The primary objective of this study was to evaluate the presence of subclinical left ventricular (LV) dysfunction with two-dimensional (2D) speckle tracking echocardiography (STE) and the secondary objective was to compare retinopathy-positive and -negative diabetic patients.
  
  
  METHODS
  A total of 82 patients with type II diabetes mellitus (DM) and 90 gender-matched healthy controls were included. Retinopathy was present in 55 patients in the study group. All study participants underwent conventional 2D echocardiography and STE.
  
  
  RESULTS
  All diabetic patients had preserved LV ejection fraction (LV-EF ≥ 50). Compared with the control group, diabetic patients had a larger left atrium (47.3 ± 19.9 mm vs. 36.9 ± 17.8 mm, p < 0.001) and a higher E/Em ratio (12.0 ± 2.9 vs. 10.5 ± 3.7, p = 0.004). The LV-EF, LV end diastolic and end systolic volumes, E/A ratios, deceleration times, and tissue Doppler parameters were compared between groups. The study group was observed to have statistically significant lower four-chamber (4C; 17.7 ± 3.0 % vs. 19.3 ± 3.5 %, p = 0.002), three-chamber (3C; 17.5 ± 3.0 % vs. 19.2 ± 3.4 %, p = 0.001), and two-chamber (2C; 18.5 ± 3.5 % vs. 20.1 ± 2.4 %, p = 0.001) peak longitudinal strain values compared with the control group. Moreover, LV global strain values were found to be significantly lower in the DM group than in the control group (17.9 ± 2.7 % vs. 21.1 ± 3.2 %, p < 0.001). By contrast, basal rotation (4.9 ± 3.3° vs.2.8 ± 4.5°, p = 0.001), apical rotation (15.3 ± 6.7° vs. 12.1 ± 5.3°, p = 0.001) and LV twist (20.2 ± 7.2° vs. 16.9 ± 6.5°, p = 0.002) in the DM group were significantly increased compared with those of controls.
  
  
  CONCLUSIONS
  The STE procedure can be a useful novel technique in the determination of subclinical LV dysfunction in diabetic patients. Diabetic patients have lower longitudinal myocardial mechanics, and circumferential and rotational mechanics are impaired. There was no significant association between diabetic retinopathy and LV function.
authors.affiliation: Cardiology Clinic, Kartal Koşuyolu Heart Research Hospital, Denizer Cad. Cevizli Kartal, 34846, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Karagöz
authors.forename: T
authors.initials: T
authors.lastname: Bezgin
authors.forename: I
authors.initials: I
authors.lastname: Kutlutürk
authors.forename: S
authors.initials: S
authors.lastname: Külahçıoğlu
authors.forename: I H
authors.initials: IH
authors.lastname: Tanboğa
authors.forename: A
authors.initials: A
authors.lastname: Güler
authors.forename: C Y
authors.initials: CY
authors.lastname: Karabay
authors.forename: V
authors.initials: V
authors.lastname: Oduncu
authors.forename: H
authors.initials: H
authors.lastname: Aksoy
authors.forename: C
authors.initials: C
authors.lastname: Kırma
mesh_terms: D003930:Diabetic Retinopathy / Q000150:complications* / Q000473:pathology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging*