title: Right heart mechanics in untreated normotensive patients with prediabetes and type 2 diabetes mellitus: a two- and three-dimensional echocardiographic study.
abstract: BACKGROUND
  The aim of this study was to determine right ventricular (RV) and right atrial (RA) deformation assessed by two-dimensional echocardiographic and three-dimensional echocardiographic (3DE) imaging in patients with prediabetes and type 2 diabetes mellitus.
  
  
  METHODS
  This cross-sectional study included 47 untreated normotensive subjects with prediabetes, 57 recently diagnosed normotensive patients with diabetes, and 54 healthy controls of similar sex and age distributions. All subjects underwent laboratory analyses and complete two-dimensional echocardiographic and 3DE examinations.
  
  
  RESULTS
  Three-dimensional echocardiographic RV end-diastolic volume index gradually decreased from controls across patients with diabetes to those with diabetes (69 ± 10 vs 63 ± 8 vs 58 ± 8 mL/m(2), P < .001), whereas 3DE RV end-systolic volume index was higher in controls compared with patients with diabetes and those with diabetes (25 ± 4 vs 23 ± 4 vs 22 ± 4 mL/m(2), P < .001). However, there was no difference in 3DE RV ejection fraction among the three groups (63 ± 4% vs 62 ± 4% vs 61 ± 5%, P = .063). RV and RA global strain and systolic and early diastolic strain rates were decreased in patients with prediabetes and in those with diabetes compared with controls, whereas RV and RA late diastolic strain rates were increased in these patients. Multivariate regression analysis showed that RV global strain was associated with glycated hemoglobin, independent of left ventricular parameters.
  
  
  CONCLUSIONS
  RV and RA myocardial deformation and function obtained by 3DE and two-dimensional echocardiographic strain, even in normal ranges, were decreased in patients with prediabetes and in those with diabetes compared with controls. The long-term parameter of glucose control was correlated with the right heart mechanics.
authors.affiliation: Department of Cardiology, University Clinical Hospital Center "Dr Dragisa Misovic - Dedinje," Belgrade, Serbia. Electronic address: marijana_tadic@hotmail.com.
authors.forename: Marijana
authors.initials: M
authors.lastname: Tadic
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
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 Endocrinology, University Clinical Hospital Center "Dr Dragisa Misovic", Belgrade, Serbia.
authors.forename: Sanja
authors.initials: S
authors.lastname: Ilic
authors.affiliation: Department of Cardiology, University Clinical Hospital Center "Dr Dragisa Misovic - Dedinje," Belgrade, Serbia.
authors.forename: Biljana
authors.initials: B
authors.lastname: Pencic
authors.affiliation: Department of Endocrinology, University Clinical Hospital Center "Dr Dragisa Misovic", Belgrade, Serbia.
authors.forename: Jana
authors.initials: J
authors.lastname: Radojkovic
authors.affiliation: Faculty of Medicine, Belgrade, Serbia; Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Branislava
authors.initials: B
authors.lastname: Ivanovic
authors.affiliation: Faculty of Medicine, Belgrade, Serbia; Institute for Medical Statistics and Informatics, Belgrade, Serbia.
authors.forename: Dejana
authors.initials: D
authors.lastname: Stanisavljevic
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Gonenc
authors.initials: G
authors.lastname: Kocabay
authors.affiliation: Department of Cardiology, University Clinical Hospital Center "Dr Dragisa Misovic - Dedinje," Belgrade, Serbia.
authors.forename: Tamara
authors.initials: T
authors.lastname: Marjanovic
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; 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; D011236:Prediabetic State / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*
keywords: Diabetes mellitus; Prediabetes; Right atrium; Right ventricle; Speckle-tracking imaging; Three-dimensional echocardiography