Subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus

Cover Page
Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract


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.


Full Text

Restricted Access

About the authors

Vladimir A. Tsvetkov

V.I. Vernadsky Crimean Federal University, Medical Academy named after S.I. Georgievsky (Academic Unit)

Author for correspondence.
Email: vlaltsvetkov@gmail.com
ORCID iD: 0000-0003-0477-0435
SPIN-code: 3224-0131

Russian Federation, Simferopol

PhD

Evgeniy S. Krutikov

V.I. Vernadsky Crimean Federal University, Medical Academy named after S.I. Georgievsky (Academic Unit)

Email: nephrostar@yandex.ru
ORCID iD: 0000-0002-5754-4418
SPIN-code: 5967-2847

Russian Federation, Simferopol

MD, PhD, Professor

Svetlana I. Chistyakova

V.I. Vernadsky Crimean Federal University, Medical Academy named after S.I. Georgievsky (Academic Unit)

Email: sve-chistyakova@yandex.ru
ORCID iD: 0000-0002-3505-2658
SPIN-code: 5117-7214

Russian Federation, Simferopol

PhD

References

  1. Rawshani A, Rawshani A, Franzén S, et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2018;379(7):633–644. doi: https://doi.org/10.1056/NEJMoa1800256
  2. Seferović PM, Petrie MC, Filippatos GS, et al. Type 2 diabetes mellitus and heart failure: a position statement from the heart failure association of the european society of cardiology. Eur J Heart Fail. 2018;20(5):853–872. doi: https://doi.org/10.1002/ejhf.1170
  3. Shah AD, Langenberg C, Rapsomaniki E, et al. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 19 million people. Lancet Diabetes Endocrinol. 2015;3(2):105–113. doi: https://doi.org/10.1016/S2213-8587(14)70219-0
  4. Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol. 1974;34(1):29–34. doi: https://doi.org/10.1016/0002-9149(74)90089-7
  5. Rosano GM, Vitale C, Seferovic P. Heart failure in patients with diabetes mellitus. Card Fail Rev. 2017;3(1):52–55. doi: https://doi.org/10.15420/cfr.2016:20:2
  6. Dei Cas A, Khan SS, Butler J, et al. Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure. JACC Heart Fail. 2015;3(2):136–145. doi: https://doi.org/10.1016/j.jchf.2014.08.004
  7. Campbell P, Krim S, Ventura H. The bi-directional impact of two chronic illnesses: heart failure and diabetes - a review of the epidemiology and outcomes. Card Fail Rev. 2015;1(1):8–10. doi: https://doi.org/10.15420/cfr.2015.01.01.8
  8. Фомин И.В. Хроническая сердечная недостаточность в Российской Федерации: что сегодня мы знаем и что должны делать // Российский кардиологический журнал. — 2016. — T. 21. — №8. — С. 7–13. [Fomin IV. Chronic heart failure in Russian Federation: what do we know and what to do. Russian journal of cardiology. 2016;21(8):7–13. (In Russ).] doi: https://doi.org/10.15829/1560-4071-2016-8-7-13
  9. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Rev Esp Cardiol (Engl Ed). 2016;69(12):1167. doi: https://doi.org/10.1016/j.rec.2016.11.005
  10. Krutikov YeS, Tsvetkov VA, Chistyakova SI. Cardiac remodeling in patients with type 2 diabetes mellitus and hypertension. New Armenian Medical Journal. 2019;13(2):4−9.
  11. Faden G, Faganello G, De Feo S, et al. The increasing detection of asymptomatic left ventricular dysfunction in patients with type 2 diabetes mellitus without overt cardiac disease: data from the shortwave study. Diabetes Res Clin Pract. 2013;101(3):309–316. doi: https://doi.org/10.1016/j.diabres.2013.07.004
  12. Selvin E, Lazo M, Chen Y, et al. Diabetes mellitus, prediabetes, and incidence of subclinical myocardial damage. Circulation. 2014;130(16):1374–1382. doi: https://doi.org/10.1161/circulationaha.114.010815
  13. Porter TR, Mulvagh SL, Abdelmoneim SS, et al. Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 American society of echocardiography guidelines update. J Am Soc Echocardiogr. 2018;31(3):241–274. doi: https://doi.org/10.1016/j.echo.2017.11.013

Supplementary files

Supplementary Files Action
1.
Fig. Types of diastolic dysfunction in patients with type 2 diabetes mellitus and arterial hypertension.

View (186KB) Indexing metadata

Statistics

Views

Abstract - 326

PDF (Russian) - 0

Cited-By


PlumX

Dimensions


Copyright (c) 2020 Tsvetkov V.A., Krutikov E.S., Chistyakova S.I.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies