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Acta Diabetologica

Published in:

19-10-2023 | Diabetes | Original Article

Evaluation of subclinical left ventricular myocardial systolic dysfunction in type 2 diabetes mellitus patients with and without diabetes peripheral neuropathy by global myocardial work

Authors: Guang-An Li, Hui-Ling Bai, Jun Huang, Qi-Yong Wu, Li Fan

Published in: Acta Diabetologica | Issue 3/2024

Abstract

Aims

Speckle-tracking echocardiography can non-invasively estimate myocardial work (MW) to evaluate left ventricular (LV) myocardial systolic function. The present study evaluated whether MW may detect subclinical LV myocardial systolic dysfunction in type 2 diabetes mellitus (T2DM) patients with and without diabetes peripheral neuropathy (DPN).

Methods

A total of 127 T2DM patients were included in the present study, including 67 T2DM patients with DPN. In addition, 73 sex- and age- matched healthy individuals served as normal controls. The global myocardial work index (GWI), global constructive work (GCW), global waste work (GWW), global positive work (GPW), global negative work (GNW), global work efficiency (GWE) and GCW/GWW were measured and analysed. Furthermore, the differences in MW parameters among normal controls, T2DM patients, and T2DM patients with DPN were analysed. Multiple regression models were built to explore for the independent influencing factors of GWI and GPW values in T2DM patients with DPN. Receiver operating characteristic curve analysis was performed to evaluate the sensitivity and specificity of MW in evaluating subclinical LV myocardial systolic dysfunction in T2DM patients with DPN.

Results

The GWI, GCW and GPW of T2DM patients with DPN were significantly decreased compared with those of T2DM patients and normal controls (P < 0.001) and showed a significant decreasing trend overall (P _trend < 0.001). GWE and GCW/GWW were significantly decreased in T2DM patients with DPN compared with normal controls (P < 0.05). Although GWW was not significantly different among the three groups, it showed an increasing trend (P_trend = 0.033). High-density lipoprotein cholesterol (HDL-C) levels were independent influencing factor for decreased GWI (β = 0.21, P = 0.031) and GPW (β = 0.19, P = 0.043) values in T2DM patients with DPN. The combination of the GWI, GCW, GWE, GPW and GCW /GWW had good sensitivity (62.69%) and specificity (89.04%) when evaluating subclinical LV myocardial systolic dysfunction in T2DM patients with DPN.

Conclusions

Non-invasive evaluation of LV myocardial work can detect subclinical LV myocardial systolic dysfunction in T2DM patients with and without DPN. DPN has additive deleterious effects on LV myocardial systolic function in T2DM patients. The reduction of HDL-C levels may indicate the occurrence of subclinical LV myocardial systolic dysfunction in T2DM patients with DPN.

Organization WH (2022) World Health Statistics 2022.

Vinereanu D (2003) Conduit arterial stiffness is associated with impaired left ventricular subendocardial function

Islam S, Kim D, Lee YS, Moon SS (2018) Association between diabetic peripheral neuropathy and heart rate variability in subjects with type 2 diabetes. Diabetes Res Clin Pract 140:18–26. https://doi.org/10.1016/j.diabres.2018.03.034CrossRefPubMed

Chen Y, Wang Y, Zhang Y, Li M, Zhang W, Zhou Y, Liu X, Fu J, Lu Z, Xu Q, Liu T, Li Z, Li X, Zhou J (2023) Association of peripheral neuropathy with subclinical left ventricular dysfunction in patients with type 2 diabetes. J Diabetes Complications 37:108406. https://doi.org/10.1016/j.jdiacomp.2023.108406CrossRefPubMed

Roemer S, Jaglan A, Santos D, Umland M, Jain R, Tajik AJ, Khandheria BK (2021) The utility of myocardial work in clinical practice. J Am Soc Echocardiogr 34:807–818. https://doi.org/10.1016/j.echo.2021.04.013CrossRefPubMed

Russell K, Eriksen M, Aaberge L, Wilhelmsen N, Skulstad H, Remme EW, Haugaa KH, Opdahl A, Fjeld JG, Gjesdal O, Edvardsen T, Smiseth OA (2012) A novel clinical method for quantification of regional left ventricular pressure-strain loop area: a non-invasive index of myocardial work. Eur Heart J 33:724–733. https://doi.org/10.1093/eurheartj/ehs016CrossRefPubMedPubMedCentral

Russell K, Eriksen M, Aaberge L, Wilhelmsen N, Skulstad H, Gjesdal O, Edvardsen T, Smiseth OA (2013) Assessment of wasted myocardial work: a novel method to quantify energy loss due to uncoordinated left ventricular contractions. Am J Physiol Heart Circ Physiol 305:H996-1003. https://doi.org/10.1152/ajpheart.00191.2013CrossRefPubMed

American Diabetes A (2013) Diagnosis and classification of diabetes mellitus. Diabetes Care 36(Suppl 1):S67-74. https://doi.org/10.2337/dc13-S067CrossRef

10.

Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, Lauria G, Malik RA, Spallone V, Vinik A, Bernardi L, Valensi P (2010) Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 33:2285–2293. https://doi.org/10.2337/dc10-1303CrossRefPubMedPubMedCentral

11.

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1–39):e14. https://doi.org/10.1016/j.echo.2014.10.003CrossRef

12.

Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 29:277–314. https://doi.org/10.1016/j.echo.2016.01.011CrossRefPubMed

13.

Matos J, Kronzon I, Panagopoulos G, Perk G (2012) Mitral annular plane systolic excursion as a surrogate for left ventricular ejection fraction. J Am Soc Echocardiogr 25:969–974. https://doi.org/10.1016/j.echo.2012.06.011CrossRefPubMed

14.

Chan J, Edwards NFA, Khandheria BK, Shiino K, Sabapathy S, Anderson B, Chamberlain R, Scalia GM (2019) A new approach to assess myocardial work by non-invasive left ventricular pressure-strain relations in hypertension and dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 20:31–39. https://doi.org/10.1093/ehjci/jey131CrossRefPubMed

15.

Kosmas CE, Rodriguez Polanco S, Bousvarou MD, Papakonstantinou EJ, Peña Genao E, Guzman E, Kostara CE (2023) The triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio as a risk marker for metabolic syndrome and cardiovascular disease. Diagnostics Basel Switzerland. https://doi.org/10.3390/diagnostics13050929CrossRefPubMed

16.

Selvarajah D, Kar D, Khunti K, Davies MJ, Scott AR, Walker J, Tesfaye S (2019) Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention. Lancet Diabetes Endocrinol 7:938–948. https://doi.org/10.1016/s2213-8587(19)30081-6CrossRefPubMed

17.

Edwards NFA, Scalia GM, Shiino K, Sabapathy S, Anderson B, Chamberlain R, Khandheria BK, Chan J (2019) Global myocardial work is superior to global longitudinal strain to predict significant coronary artery disease in patients with normal left ventricular function and wall motion. J Am Soc Echocardiogr 32:947–957. https://doi.org/10.1016/j.echo.2019.02.014CrossRefPubMed

18.

Clemmensen TS, Eiskjaer H, Mikkelsen F, Granstam SO, Flachskampf FA, Sorensen J, Poulsen SH (2020) Left ventricular pressure-strain-derived myocardial work at rest and during exercise in patients with cardiac amyloidosis. J Am Soc Echocardiogr 33:573–582. https://doi.org/10.1016/j.echo.2019.11.018CrossRefPubMed

19.

Anjaneyulu M, Berent-Spillson A, Inoue T, Choi J, Cherian K, Russell JW (2008) Transforming growth factor-beta induces cellular injury in experimental diabetic neuropathy. Exp Neurol 211:469–479. https://doi.org/10.1016/j.expneurol.2008.02.011CrossRefPubMedPubMedCentral

20.

Kellogg AP, Wiggin TD, Larkin DD, Hayes JM, Stevens MJ, Pop-Busui R (2007) Protective effects of cyclooxygenase-2 gene inactivation against peripheral nerve dysfunction and intraepidermal nerve fiber loss in experimental diabetes. Diabetes 56:2997–3005. https://doi.org/10.2337/db07-0740CrossRefPubMed

21.

Vincent AM, Russell JW, Low P, Feldman EL (2004) Oxidative stress in the pathogenesis of diabetic neuropathy. Endocr Rev 25:612–628. https://doi.org/10.1210/er.2003-0019CrossRefPubMed

22.

Cowie MR, Fisher M (2020) SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control. Nat Rev Cardiol 17:761–772. https://doi.org/10.1038/s41569-020-0406-8CrossRefPubMed

Title: Evaluation of subclinical left ventricular myocardial systolic dysfunction in type 2 diabetes mellitus patients with and without diabetes peripheral neuropathy by global myocardial work
Authors: Guang-An Li
Hui-Ling Bai
Jun Huang
Qi-Yong Wu
Li Fan
Publication date: 19-10-2023
Publisher: Springer Milan
Keywords: Diabetes
Echocardiography
Echocardiography
Type 2 Diabetes
Published in: Acta Diabetologica / Issue 3/2024
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-023-02197-7

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