title: Left Ventricular Mechanics in Untreated Normotensive Patients with Type 2 Diabetes Mellitus: A Two- and Three-dimensional Speckle Tracking Study.
abstract: BACKGROUND
  Our aim was to investigate left ventricular (LV) mechanics estimated by two- (2DE) and three-dimensional echocardiography (3DE) strains in subjects with type 2 diabetes mellitus (DM).
  
  
  METHODS
  This cross-sectional study included 50 untreated normotensive DM subjects and 50 healthy controls similar by sex and age. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination.
  
  
  RESULTS
  Left ventricular mechanics, assessed by 2DE, was impaired in all three directions. Global longitudinal 3DE strain was significantly decreased in the DM group in comparison with the controls (-17.8 ± 2.5 vs. -19.1 ± 2.7%, P = 0.014). Similar results were found for 3DE global circumferential strain (-18.9 ± 2.9 vs. -20.4 ± 3.2%, P = 0.01), 3DE global radial strain (40.3 ± 6.9 vs. 43.1 ± 7.3%, P = 0.035), and 3DE global area strain (-29.2 ± 3.7 vs. -31 ± 4%, P = 0.024). LV torsion was similar between the DM patients and the controls (2.1 ± 0.6 vs. 1.9 ± 0.5 °/cm, P = 0.073); whereas LV untwisting rate was significantly increased in the DM subjects (-114 ± 26 vs. -96 ±23 °/s, P < 0.001). A multivariate analysis showed that 3DE global longitudinal and area myocardial functions were associated with HbA1c independently of 3DE LV mass index.
  
  
  CONCLUSIONS
  Left ventricular deformation obtained by 3DE is significantly impaired in the type 2 DM patients. HbA1c is independently associated with LV mechanics that implies that early anti-diabetic therapy and normalization of the fasting glucose level and HbA1c could impede further cardiac damage.
authors.affiliation: Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia.
authors.forename: Marijana
authors.initials: M
authors.lastname: Tadic
authors.affiliation: Department of Endocrinology, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia.
authors.forename: Sanja
authors.initials: S
authors.lastname: Ilic
authors.affiliation: Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Cuspidi
authors.affiliation: Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia.
authors.forename: Biljana
authors.initials: B
authors.lastname: Stojcevski
authors.affiliation: Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.|Faculty of Medicine, Belgrade, Serbia.
authors.forename: Branislava
authors.initials: B
authors.lastname: Ivanovic
authors.affiliation: Department of Pharmacology, Faculty of Medicine, Belgrade, Serbia.
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Bukarica
authors.affiliation: Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia.
authors.forename: Ljilja
authors.initials: L
authors.lastname: Jozika
authors.affiliation: Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia.|Faculty of Medicine, Belgrade, Serbia.
authors.forename: Vera
authors.initials: V
authors.lastname: Celic
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000000981:diagnostic imaging*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*
keywords: diabetes mellitus; left ventricle; speckle tracking imaging; three-dimensional echocardiography