title: Altered myocardial response in patients with diabetic retinopathy: an exercise echocardiography study.
abstract: BACKGROUND
  Type 2 diabetes mellitus (T2DM) complicated by retinopathy is associated with altered left ventricular (LV) structure and resting myocardial dysfunction unlike T2DM without retinopathy. The myocardial response to stress has not been compared in patients with and without diabetic retinopathy. The aim of this retrospective study was to determine the relationship between retinopathy and myocardial function in patients with T2DM at rest and during exercise echocardiography.
  
  
  METHODS
  134 patients with T2DM and no evidence of underlying coronary artery disease were recruited. All patients underwent retinal photography to screen for diabetic retinopathy, and resting and exercise echocardiography. Resting echocardiography was analyzed by conventional echocardiographic parameters and speckle tracking derived global longitudinal strain (GLS). Exercise echocardiography parameters included diastolic function reserve index (DFRI) and stress GLS.
  
  
  RESULTS
  The mean age of participants was 60 years and 49% were male. Diabetic retinopathy was identified in 43 patients (32%). Resting echocardiography revealed that those with diabetic retinopathy had a higher prevalence of impaired diastolic function, higher E/E' ratio (LV filling pressures) and impaired resting GLS compared with those without. Exercise echocardiography revealed that those with diabetic retinopathy also had more impaired DFRI and stress GLS. Multivariable analysis showed that the presence of diabetic retinopathy was independently associated with high resting E/E', diastolic dysfunction grade, impaired resting GLS, low DFRI and impaired stress GLS.
  
  
  CONCLUSIONS
  In conclusion, the presence of diabetic retinopathy was independently associated with impaired resting myocardial function (diastolic and systolic function) and myocardial function during stress (evaluated by DFRI and stress GLS).
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Rm 1929b, Block K, Hong Kong, China. zhenzhe717@gmail.com.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhen
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Rm 1929b, Block K, Hong Kong, China. 290505880@qq.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. kendrick.shih@gmail.com.
authors.forename: Kendrick
authors.initials: K
authors.lastname: Shih
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Rm 1929b, Block K, Hong Kong, China. juhualiu1984@163.com.
authors.forename: Ju-Hua
authors.initials: JH
authors.lastname: Liu
authors.affiliation: Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. micheleyuen@hotmail.com.
authors.forename: Michele
authors.initials: M
authors.lastname: Yuen
authors.affiliation: Department of Ophthalmology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. shdwong@hku.hk.
authors.forename: David Sai-Hung
authors.initials: DS
authors.lastname: Wong
authors.affiliation: Division of Endocrinology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. ksllam@hku.hk.|Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. ksllam@hku.hk.
authors.forename: Karen Siu-Ling
authors.initials: KS
authors.lastname: Lam
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Rm 1929b, Block K, Hong Kong, China. hftse@hkucc.hku.hk.|Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. hftse@hkucc.hku.hk.
authors.forename: Hung-Fat
authors.initials: HF
authors.lastname: Tse
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Rm 1929b, Block K, Hong Kong, China. khkyiu@hku.hk.|Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. khkyiu@hku.hk.|Department of Medicine, The University of Hong Kong ShenZhen Hospital, Shenzhen, China. khkyiu@hku.hk.
authors.forename: Kai-Hang
authors.initials: KH
authors.lastname: Yiu
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000209:etiology*; D018619:Echocardiography, Doppler, Pulsed; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D017725:Ventricular Pressure