# 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.

## Key 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.