title: Patients with Diabetes and Significant Epicardial Coronary Artery Disease Have Increased Systolic Left Ventricular Apical Rotation and Rotation Rate at Rest.
abstract: OBJECTIVE
  The purpose of this study was to determine whether resting myocardial deformation and rotation may be altered in diabetic patients with significant epicardial coronary artery disease (CAD) with normal left ventricular ejection fraction.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  Diagnosis of epicardial CAD in patients with diabetes.
  
  
  METHODS
  Eighty-four patients with diabetes suspected of epicardial CAD scheduled for cardiac catheterization had a resting echocardiogram performed prior to their procedure. Echocardiographic measurements were compared between patients with and without significant epicardial CAD as determined by cardiac catheterization.
  
  
  METHODS
  Measurement of longitudinal strain, strain rate, apical rotation, and rotation rate, using speckle tracking echocardiography.
  
  
  RESULTS
  Eighty-four patients were studied, 39 (46.4%) of whom had significant epicardial CAD. Global peak systolic apical rotation was significantly increased (14.9 ± 5.1 vs. 11.0 ± 4.8 degrees, P < 0.001) in patients with epicardial CAD along with faster peak systolic apical rotation rate (90.4 ± 29 vs. 68.1 ± 22.2 degrees/sec, P < 0.001). These findings were further confirmed through multivariate logistic regression analysis (global peak systolic apical rotation OR = 1.17, P = 0.004 and peak systolic apical rotation rate OR = 1.05, P < 0.001).
  
  
  CONCLUSIONS
  Patients with diabetes with significant epicardial CAD and normal LVEF exhibit an increase in peak systolic apical counterclockwise rotation and rotation rate detected by echocardiography, suggesting that significant epicardial CAD and its associated myocardial effects in patients with diabetes may be detected noninvasively at rest.
authors.affiliation: Cardiovascular Division, Boston Veterans Affairs Medical Center, West Roxbury, Massachusetts.
authors.forename: Ravi
authors.initials: R
authors.lastname: Rasalingam
authors.affiliation: Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Indiana.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Holland
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Cooper
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rich
authors.affiliation: Department of Physics, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: James G
authors.initials: JG
authors.lastname: Miller
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Julio E
authors.initials: JE
authors.lastname: Pérez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D048909:Diabetes Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012399:Rotation; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology
keywords: coronary artery disease; diabetes; echocardiography; myocardial strain