title: Subclinical impairment of left ventricular function in diabetic patients with or without obesity: A study based on three-dimensional speckle tracking echocardiography.
abstract: OBJECTIVE
  The aim of this study was to investigate subclinical left ventricular (LV) changes between type 2 diabetic patients with or without obesity using three-dimensional speckle-tracking echocardiography (3DSTE).
  
  
  METHODS
  A total of 77 type 2 diabetic patients, including 36 subjects with BMI < 25 kg/m(2) and 41 subjects with BMI ≥ 25 kg/m(2), as well as 40 age- and sex-matched controls (BMI: 18.5 ~ 24.5 kg/m(2)) were studied. Waist circumference was measured in diabetic patients with a BMI ≥ 25 kg/m(2) to determine whether abdominal obesity as a complication was present. Real-time three-dimensional (3D) full volume images of the left ventricle were recorded and analyzed. Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were calculated and compared.
  
  
  RESULTS
  Compared with the controls, diabetic subjects without overall obesity had significantly lower GCS, GAS, and GRS (p < 0.05), as well as markedly lower GLS (p < 0.001). However, 3D-LVEF and all global strains in diabetic subjects with overall obesity were not only markedly lower compared with controls (p  <  0.002 and p < 0.001), but also significantly lower than those in diabetic subjects without overall obesity (p  <  0.002 and p  <  0.05). HbA1c and BMI showed negative impacts on all strains in diabetic patients. Meanwhile, the diabetic subjects with overall and abdominal obesity had significantly reduced GLS, GCS, GAS, and GRS compared with those with overall obesity only (all p  <  0.05).
  
  
  CONCLUSIONS
  Type 2 diabetic patients demonstrated early-stage subclinical LV deformation and dysfunction, whilst coexistent obesity resulted in further damage to myocardial contractility and reduced LVEF. 3DSTE was a sensitive method for detecting these abnormalities.
authors.affiliation: Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, No. 183 Xinqiao Street, Chongqing, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.forename: Y
authors.initials: Y
authors.lastname: Gao
authors.forename: K
authors.initials: K
authors.lastname: Tan
authors.forename: P
authors.initials: P
authors.lastname: Li
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*