A Correlation Between Left Ventricular Systolic Dysfunction, Identified on Global Longitudinal Strain, and Inducible Ischemia on 2D Stress Echocardiography in Type 2 Diabetes With Preserved Ejection Fraction

TL;DR

This study finds that heart strain measured by GLS in type 2 diabetes patients with normal ejection fraction is linked to stress test results and worse diabetes control.

Contribution

The study identifies a novel correlation between GLS-measured systolic dysfunction and inducible ischemia in T2DM patients with preserved ejection fraction.

Findings

37.7% of T2DM patients with preserved ejection fraction showed reduced GLS indicating systolic dysfunction.

Reduced GLS was associated with higher HbA1c levels, longer diabetes duration, and older age.

Stress echocardiography positivity was significantly higher in patients with reduced GLS.

Abstract

Background: The relationship between glycemic control and cardiovascular outcomes is significant. Subclinical systolic impairment could be the first indicator of diabetic cardiomyopathy, even before detectable changes in ejection fraction.

Aim: To determine the prevalence of left ventricular (LV) systolic dysfunction by global longitudinal strain (GLS) in patients with asymptomatic type 2 diabetes mellitus (T2DM) patients with preserved ejection fraction and correlate GLS with stress echocardiography positivity rates in these patients.

Methods: This prospective, observational, cross-sectional, single-center study included 150 asymptomatic T2DM patients with preserved left ventricular ejection fraction (LVEF≥50%). Patients underwent comprehensive echocardiography, which included GLS measurement and stress echocardiography. Patients were categorized based on GLS values (normal:≥-17%; reduced:<-17%) and stress echocardiography results.

Results: The LV systolic dysfunction, defined by reduced GLS, was observed in 37.7% of patients. Patients with reduced GLS were older (64.42±11.01 vs. 55.09±12.20 years, p<0.001), had higher HbA1c levels (8.6±0.99% vs. 7.05±1.05%, p<0.001), and longer diabetes duration (10.43±5.59 vs. 6.32±5.90 years, p<0.001). Stress echocardiography positivity was significantly higher in the reduced GLS group compared to the normal GLS group (17.9% vs 4.3%, p=0.006). Patients with positive stress echocardiography results showed significantly lower average GLS compared to those with negative results (16.16±3.96% vs 18.69±3.45%, p=0.04).

Conclusions: In asymptomatic T2DM patients with preserved LVEF, reduced GLS is associated with a higher rate of positive stress echocardiography results. The LV systolic dysfunction, indicated by reduced GLS, is common in diabetic patients and associated with higher HbA1c and longer diabetes duration.