Key result
An increased burden of diabetes-related microvascular complications was independently associated with reduced global longitudinal strain (β 0.50) in asymptomatic patients with diabetes mellitus and non-obstructive coronary artery disease.
Why the study?
Reduced left ventricular function is observed in asymptomatic diabetes mellitus and microvascular complications, but its association with plaque burden and microvascular disease was unclear.
Cross-Sectional (n=222)
No
In asymptomatic patients with diabetes and non-obstructive coronary artery disease, an increasing burden of microvascular complications is independently associated with reduced left ventricular global longitudinal strain.
Microvascular complications were associated with reduced GLS independent of plaque burden in asymptomatic DM; hypothesis-generating for prospective studies before any screening implications.
BACKGROUND: Reduced left ventricular function, assessed by global longitudinal strain (GLS), is sometimes observed in asymptomatic patients with diabetes mellitus (DM) and is often present in patients with diabetes-related microvascular complications. Our aim was to assess the association between microvascular complications, coronary artery plaque burden (PB) and GLS in asymptomatic patients with DM and non-obstructive coronary artery disease (CAD). METHODS: This cross-sectional study included patients with DM without any history, symptoms or objective evidence of obstructive CAD. All patients were identified in the outpatient Clinic of Endocrinology at Odense University Hospital Svendborg. An echocardiography and a coronary computed tomography angiography were performed to assess GLS and the degree of CAD, respectively. A coronary artery stenosis < 50% was considered non-obstructive. A linear regression model was used to evaluate the impact of potential confounders on GLS with adjustment of body mass index (BMI), mean arterial pressure (MAP), microvascular complications, type of diabetes, tissue Doppler average early diastolic mitral annulus velocity (e') and PB. RESULTS: Two hundred and twenty-two patients were included, of whom 172 (77%) had type 2 DM and 50 (23%) had type 1 diabetes. One hundred and eleven (50%) patients had microvascular complications. GLS decreased as the burden of microvascular complications increased (P-trend = 0.01): no microvascular complications, GLS (- 16.4 ± 2.5%), 1 microvascular complication (- 16.0 ± 2.5%) and 2-3 microvascular complications (- 14.9 ± 2.8%). The reduction in GLS remained significant after multivariable adjustment (β 0.50 [95% CI 0.11-0.88], p = 0.01). BMI (β 0.12 [95% CI 0.05-0.19]) and MAP (β 0.05 [95% CI 0.01-0.08]) were associated with reduced GLS. In addition, an increased number of microvascular complications was associated with increased PB (β 2.97 [95% CI 0.42-5.51], p = 0.02) in a univariable linear regression model, whereas there was no significant association between PB and GLS. CONCLUSIONS: The burden of microvascular complications was associated with reduced GLS independent of other cardiovascular risk factors in asymptomatic patients with DM and non-obstructive CAD. In addition, the burden of microvascular complications was associated with increasing PB, whereas PB was not associated with GLS.
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Pararajasingam et al. (2021) conducted a cross-sectional in Diabetes mellitus (n=222). Burden of microvascular complications vs. No microvascular complications was evaluated on Global longitudinal strain (GLS) (β 0.50, 95% CI 0.11-0.88, p=0.01). An increased burden of diabetes-related microvascular complications was independently associated with reduced global longitudinal strain (β 0.50) in asymptomatic patients with diabetes mellitus and non-obstructive coronary artery disease.
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