Investigation of the Possible Risk Factors Associated with Subclinical Left Ventricular Dysfunction Assessed by 2D Speckle Tracking Echocardiography in Patients with Type 2 Diabetes Mellitus and Normal Ejection Fraction

Background: Subclinical left ventricular dysfunction is an important predictor of cardiovascular death, detected via the global longitudinal strain (GLS) echocardiographic parameter. While T2DM is associated with a worse GLS, it is not cost-effective to perform 2D speckle tracking echocardiography for all asymptomatic T2DM patients to screen for early signs of subclinical left ventricular dysfunction.

Objectives: We aimed to investigate the association of possible risk factors with subclinical left ventricular dysfunction assessed by 2D speckle tracking echocardiography in T2DM patients with normal ejection fraction, excluding patients with comorbidities associated with left ventricular dysfunction such as hypertension or any cardiovascular disease.

Methods: This cross-sectional study involved patients aged >18 with type 2 diabetes mellitus (T2DM) and EF ≥ 50% referred to Shohada-e-Tajrish Hospital, Tehran, Iran, from May 2, 2023, to June 21, 2023. Patients with any history or signs and symptoms of heart disease and hypertension were excluded. The correlation of GLS with age, BMI, duration of diabetes, systolic (SBP) and diastolic blood pressure (DBP), and laboratory parameters was assessed using Pearson's correlation test, with P < 0.05 denoting significance.

Results: In this cross-sectional study, 118 patients consisting of 70 women (59.32%) and 48 men (40.68%) with T2DM were enrolled. The mean age of the participants was 49.61 ± 5.10 years. The mean GLS was -16.71 ± 2.14%. The GLS correlated positively with BMI (P = 0.038 and r = 0.197), SBP (P = 0.003 and r = 0.268), DBP (P = 0.023 and r = 0.209), homocysteine (P = 0.001 and r = 0.310), HbA1C (P = 0.046 and r = 0.184), LDL (P = 0.034 and r = 0.203), and TG (P < 0.001 and r = 0.375), and negatively with GFR (P < 0.001 and r = -0.363).

Conclusions: BMI, SBP, DBP, homocysteine, HbA1C, LDL, TG, and GFR correlated with subclinical left ventricular dysfunction assessed by GLS in patients with T2DM; these markers may offer value in selecting T2DM patients for cost-effective 2D speckle tracking echocardiography screening of subclinical left ventricular dysfunction.