Quantitative evaluation of subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus by three-dimensional echocardiography

Left ventricular (LV) function undergoes subtle changes (subclinical left ventricular dysfunction) in a large proportion of patients with type 2 diabetes (T2DM) who develop diabetic cardiomyopathy. This study aimed to quantify LV myocardial strain and synchrony in T2DM by real-time three-dimensional echocardiography (RT-3DE), and to evaluate subclinical LV dysfunction in T2DM at different glycemic control levels. Seventy-two patients with T2DM with an LV ejection fraction (LVEF) ≥ 55% and 45 healthy individuals as controls who underwent RT-3DE were studied. Patients were also subdivided into the DMa group (glycosylated hemoglobin < 7%, n = 38) and the DMb group (glycosylated hemoglobin ≥ 7%, n = 34). Three-dimensional strain and synchronization parameters of the left ventricle were measured by RT-3DE and compared among the three groups. Despite a similar LVEF, global longitudinal strain (GLS), global circumferential strain (GCS), and global area strain (GAS) in the DMb group were lower, and the standard deviation of peak time (Tm-SD) and the maximum difference in peak time (Tm-Dif) in the DMb group higher, than those in the control and DMa groups (all p < 0.05). Multivariable linear regression analysis showed that the duration of diabetes was independently associated with GCS (β =  − 0.516, p < 0.001) and GAS (β =  − 0.391, p = 0.005). HbA1c levels were independently associated with GLS (β =  − 0.675, p < 0.001), Tm-SD (β = 3.363, p < 0.001), and Tm-Dif (β = 3.895, p < 0.001). RT-3DE can detect subclinical myocardial dysfunction in poor glycemic control of T2DM, and myocardial dysfunction is associated with the duration of diabetes and HbA1c.