Subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus

BACKGROUND: Recent studies have shown a high prevalence of asymptomatic forms of heart failure in patients with type 2 diabetes mellitus. The presence of even subclinical forms of heart failure in type 2 DM is associated with a negative prognosis of the disease, leading to a significant increase in the frequency of hospitalizations and mortality.

AIMS: Identification of left ventricle subclinical dysfunction in terms of its diastolic function, deformation parameters and rotational properties of the myocardium in patients with type 2 diabetes.

METHODS: A prospective case-control single-center study, performed simultaneously in groups of patients with type 2 diabetes and hypertension. To identify left ventricular dysfunction (LV), an echocardiographic study was performed, including tissue dopplerography and Speckle Tracking Echocardiography in 2D and 3D modes.

RESULTS: We examined four groups of patients comparable in age and sex distribution, with no obvious clinical signs of heart failure. Group I comprised 56 patients with type 2 diabetes and moderate hypertension. Group II included 52 patients with type 2 diabetes without an increase of blood pressure. Group III (54 people) consisted of patients with essential II degree hypertension without diabetes. Group IV (control) — 30 healthy individuals. The use of tissue dopplerography and Speckle Tracking Echocardiography allows more often (p<0.05) to detect signs of LV dysfunction in patients with type 2 diabetes compared with routine echocardiography methods. It was found that in patients with a combination of type 2 diabetes and moderate hypertension, a prognostically unfavorable restrictive variant of diastolic dysfunction is more common (p<0.05) in contrast to patients with diabetes without hypertension or those with hypertension without diabetes. The combination of type 2 diabetes and hypertension to a greater extent leads to an increase in the longitudinal global deformation of the left ventricle compared with patients who had only one of these diseases (p<0.05). A decrease in the global area strain, an early marker of LV systolic dysfunction, was expressed (p<0.05) in patients with type 2 diabetes, regardless of the presence of concomitant hypertension.

CONCLUSIONS: This study shows the importance of using tissue dopplerography and Speckle Tracking Echocardiography in the diagnosis of subclinical heart failure. The results indicate a high prevalence of subclinical systolic-diastolic LV dysfunction in type 2 diabetes, which is aggravated in the presence of concomitant hypertension in patients without obvious clinical signs of heart failure and other cardiovascular diseases.

diabetes mellitus, hypertension, heart failure, echocardiography

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