Left Ventricular Mechanics in Untreated Normotensive Patients with Type 2 Diabetes Mellitus: A Two- and Three-dimensional Speckle Tracking Study

BackgroundOur aim was to investigate left ventricular (LV) mechanics estimated by two- (2DE) and three-dimensional echocardiography (3DE) strains in subjects with type 2 diabetes mellitus (DM). MethodsThis cross-sectional study included 50 untreated normotensive DM subjects and 50 healthy controls similar by sex and age. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination. ResultsLeft ventricular mechanics, assessed by 2DE, was impaired in all three directions. Global longitudinal 3DE strain was significantly decreased in the DM group in comparison with the controls (-17.82.5 vs. -19.1 +/- 2.7%, P=0.014). Similar results were found for 3DE global circumferential strain (-18.9 +/- 2.9 vs. -20.4 +/- 3.2%, P=0.01), 3DE global radial strain (40.3 +/- 6.9 vs. 43.1 +/- 7.3%, P=0.035), and 3DE global area strain (-29.2 +/- 3.7 vs. -31 +/- 4%, P=0.024). LV torsion was similar between the DM patients and the controls (2.1 +/- 0.6 vs. 1.9 +/- 0.5 degrees/cm, P=0.073); whereas LV untwisting rate was significantly increased in the DM subjects (-114 +/- 26 vs. -96 +/- 23 degrees/s, P<0.001). A multivariate analysis showed that 3DE global longitudinal and area myocardial functions were associated with HbA1c independently of 3DE LV mass index. ConclusionLeft ventricular deformation obtained by 3DE is significantly impaired in the type 2 DM patients. HbA1c is independently associated with LV mechanics that implies that early anti-diabetic therapy and normalization of the fasting glucose level and HbA1c could impede further cardiac damage.