Dobutamine Stress Echocardiography Unmasks Early Left Ventricular Dysfunction in Asymptomatic Patients with Uncomplicated Type 2 Diabetes: A Comprehensive Two-Dimensional Speckle-Tracking Imaging Study
Discrepancies are present in the literature on resting myocardial mechanics in patients with uncomplicated type 2 diabetes mellitus (T2DM). Data are noticeably sparse regarding circumferential function and torsional mechanics. Resting deformation imaging may not be sensitive enough to detect subtle...
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| description | Discrepancies are present in the literature on resting myocardial mechanics in patients with uncomplicated type 2 diabetes mellitus (T2DM). Data are noticeably sparse regarding circumferential function and torsional mechanics. Resting deformation imaging may not be sensitive enough to detect subtle dysfunctions. The aim of this study was thus to comprehensively evaluate myocardial mechanics in patients with T2DM at rest and to investigate whether dobutamine stress echocardiography could unmask functional alterations that would remain otherwise subtle at rest.
Forty-four patients with T2DM and 35 healthy control subjects of similar age and sex were prospectively recruited. After conventional echocardiography, myocardial mechanics was evaluated at rest and during low-dose dobutamine stress echocardiography (target heart rate, 110 beats/min).
Patients with T2DM presented with altered global diastolic function but preserved systolic function. Deformation imaging indexes were similar between groups at rest, but significant differences were noticed under dobutamine infusion for longitudinal strain (−21.2 ± 2.4% vs −24.2 ± 2.5%, P |
| doi_str_mv | 10.1016/j.echo.2017.12.006 |
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Forty-four patients with T2DM and 35 healthy control subjects of similar age and sex were prospectively recruited. After conventional echocardiography, myocardial mechanics was evaluated at rest and during low-dose dobutamine stress echocardiography (target heart rate, 110 beats/min).
Patients with T2DM presented with altered global diastolic function but preserved systolic function. Deformation imaging indexes were similar between groups at rest, but significant differences were noticed under dobutamine infusion for longitudinal strain (−21.2 ± 2.4% vs −24.2 ± 2.5%, P < .001), circumferential strain (apex, −32.3 ± 5.3% vs −36.3 ± 5.3%, P = .002; papillary muscle, −25.6 ± 3.2% vs −28.0 ± 3.6%, P = .001; base, −23.2 ± 3.6% vs −25.3 ± 3.8%, P = .03), apical (11.2 ± 4.4° vs 14.1 ± 6.3°, P = .020) and basal (−12.2 ± 3.3° vs −14.3 ± 3.9°, P = .021) rotation, and twist (21.9 ± 5.9° vs 26.8 ± 8.3°, P = .007). Multivariate analysis identified epicardial fat, dyslipidemia, and fasting glycaemia as significant contributors to the changes from rest to dobutamine.
These findings demonstrate the usefulness of dobutamine stress echocardiography in establishing impairments in myocardial mechanics in patients with uncomplicated T2DM. Systemic metabolic disturbances and epicardial fat act as the main contributors to the blunted response to dobutamine stress in these patients.
•Regional myocardial dysfunction is imperceptible at rest in patients with uncomplicated T2DM.•DB stress reveals early regional myocardial dysfunction and can serve as a diagnostic tool.•Cardiac functional reserve is lost in response to myocardial stress.•Factors responsible for the blunted myocardial response to β-adrenergic stimulation are delineated.•These findings enable better understanding of the central origin of exercise intolerance in patients with T2DM.</description><identifier>ISSN: 0894-7317</identifier><identifier>EISSN: 1097-6795</identifier><identifier>DOI: 10.1016/j.echo.2017.12.006</identifier><identifier>PMID: 29526563</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Asymptomatic patients ; Cardiology and cardiovascular system ; Dobutamine stress echocardiography ; Epicardial adipose tissue ; Human health and pathology ; Life Sciences ; Regional myocardial function ; Speckle-tracking imaging ; Uncomplicated type 2 diabetes</subject><ispartof>Journal of the American Society of Echocardiography, 2018-05, Vol.31 (5), p.587-597</ispartof><rights>2018 American Society of Echocardiography</rights><rights>Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-42633a3d11d1b6c4153991cbff78567d16e430dc0891e363ca2ae46a3bfea3d3</citedby><cites>FETCH-LOGICAL-c390t-42633a3d11d1b6c4153991cbff78567d16e430dc0891e363ca2ae46a3bfea3d3</cites><orcidid>0000-0001-9557-1962 ; 0000-0002-9065-9399 ; 0000-0002-0669-0263 ; 0000-0003-0472-6338 ; 0000-0001-7797-1137</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.echo.2017.12.006$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29526563$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-03363939$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Philouze, Clothilde</creatorcontrib><creatorcontrib>Obert, Philippe</creatorcontrib><creatorcontrib>Nottin, Stéphane</creatorcontrib><creatorcontrib>Benamor, Asma</creatorcontrib><creatorcontrib>Barthez, Olivier</creatorcontrib><creatorcontrib>Aboukhoudir, Falah</creatorcontrib><title>Dobutamine Stress Echocardiography Unmasks Early Left Ventricular Dysfunction in Asymptomatic Patients with Uncomplicated Type 2 Diabetes: A Comprehensive Two-Dimensional Speckle-Tracking Imaging Study</title><title>Journal of the American Society of Echocardiography</title><addtitle>J Am Soc Echocardiogr</addtitle><description>Discrepancies are present in the literature on resting myocardial mechanics in patients with uncomplicated type 2 diabetes mellitus (T2DM). Data are noticeably sparse regarding circumferential function and torsional mechanics. Resting deformation imaging may not be sensitive enough to detect subtle dysfunctions. The aim of this study was thus to comprehensively evaluate myocardial mechanics in patients with T2DM at rest and to investigate whether dobutamine stress echocardiography could unmask functional alterations that would remain otherwise subtle at rest.
Forty-four patients with T2DM and 35 healthy control subjects of similar age and sex were prospectively recruited. After conventional echocardiography, myocardial mechanics was evaluated at rest and during low-dose dobutamine stress echocardiography (target heart rate, 110 beats/min).
Patients with T2DM presented with altered global diastolic function but preserved systolic function. Deformation imaging indexes were similar between groups at rest, but significant differences were noticed under dobutamine infusion for longitudinal strain (−21.2 ± 2.4% vs −24.2 ± 2.5%, P < .001), circumferential strain (apex, −32.3 ± 5.3% vs −36.3 ± 5.3%, P = .002; papillary muscle, −25.6 ± 3.2% vs −28.0 ± 3.6%, P = .001; base, −23.2 ± 3.6% vs −25.3 ± 3.8%, P = .03), apical (11.2 ± 4.4° vs 14.1 ± 6.3°, P = .020) and basal (−12.2 ± 3.3° vs −14.3 ± 3.9°, P = .021) rotation, and twist (21.9 ± 5.9° vs 26.8 ± 8.3°, P = .007). Multivariate analysis identified epicardial fat, dyslipidemia, and fasting glycaemia as significant contributors to the changes from rest to dobutamine.
These findings demonstrate the usefulness of dobutamine stress echocardiography in establishing impairments in myocardial mechanics in patients with uncomplicated T2DM. Systemic metabolic disturbances and epicardial fat act as the main contributors to the blunted response to dobutamine stress in these patients.
•Regional myocardial dysfunction is imperceptible at rest in patients with uncomplicated T2DM.•DB stress reveals early regional myocardial dysfunction and can serve as a diagnostic tool.•Cardiac functional reserve is lost in response to myocardial stress.•Factors responsible for the blunted myocardial response to β-adrenergic stimulation are delineated.•These findings enable better understanding of the central origin of exercise intolerance in patients with T2DM.</description><subject>Asymptomatic patients</subject><subject>Cardiology and cardiovascular system</subject><subject>Dobutamine stress echocardiography</subject><subject>Epicardial adipose tissue</subject><subject>Human health and pathology</subject><subject>Life Sciences</subject><subject>Regional myocardial function</subject><subject>Speckle-tracking imaging</subject><subject>Uncomplicated type 2 diabetes</subject><issn>0894-7317</issn><issn>1097-6795</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kcGO0zAURSMEYsrAD7BAXsIixY4Tp0FsqnZgRqoEUgtb68V5ad0mccZ2Osrf8C0s-SocdZglGz_Z79y78Imit4zOGWXi43GO6mDmCWX5nCVzSsWzaMZokcciL7Ln0YwuijTOOcuvolfOHSml2YLSl9FVUmSJyASfRX_Wphw8tLpDsvUWnSM3oVSBrbTZW-gPI_nRteBOYQG2GckGa09-YuetVkMDlqxHVw-d8tp0RHdk6ca296YFrxX5Hs6AOvKg_SEUKdP2jVbgsSK7sUeSkLWGEj26T2T5-9cq7C0esHP6jGT3YOK1bqeb6aAh2x7VqcF4Z0GddLcndy3sp7n1QzW-jl7U0Dh88zivo92Xm93qNt58-3q3Wm5ixQvq4zQRnAOvGKtYKVTKMl4UTJV1nS8ykVdMYMpppcLnMeSCK0gAUwG8rDHE-HX04VJ7gEb2VrdgR2lAy9vlRk5vlIdUwYszC-z7C9tbcz-g87LVTmHTQIdmcDKo44zyNJ3Q5IIqa5yzWD91Myon3fIoJ91TJpcskUF3CL177B_KFqunyD-_Afh8ATB8yFmjlU4FIQorbVF5WRn9v_6_ih_Alw</recordid><startdate>201805</startdate><enddate>201805</enddate><creator>Philouze, Clothilde</creator><creator>Obert, Philippe</creator><creator>Nottin, Stéphane</creator><creator>Benamor, Asma</creator><creator>Barthez, Olivier</creator><creator>Aboukhoudir, Falah</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0001-9557-1962</orcidid><orcidid>https://orcid.org/0000-0002-9065-9399</orcidid><orcidid>https://orcid.org/0000-0002-0669-0263</orcidid><orcidid>https://orcid.org/0000-0003-0472-6338</orcidid><orcidid>https://orcid.org/0000-0001-7797-1137</orcidid></search><sort><creationdate>201805</creationdate><title>Dobutamine Stress Echocardiography Unmasks Early Left Ventricular Dysfunction in Asymptomatic Patients with Uncomplicated Type 2 Diabetes: A Comprehensive Two-Dimensional Speckle-Tracking Imaging Study</title><author>Philouze, Clothilde ; Obert, Philippe ; Nottin, Stéphane ; Benamor, Asma ; Barthez, Olivier ; Aboukhoudir, Falah</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-42633a3d11d1b6c4153991cbff78567d16e430dc0891e363ca2ae46a3bfea3d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Asymptomatic patients</topic><topic>Cardiology and cardiovascular system</topic><topic>Dobutamine stress echocardiography</topic><topic>Epicardial adipose tissue</topic><topic>Human health and pathology</topic><topic>Life Sciences</topic><topic>Regional myocardial function</topic><topic>Speckle-tracking imaging</topic><topic>Uncomplicated type 2 diabetes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Philouze, Clothilde</creatorcontrib><creatorcontrib>Obert, Philippe</creatorcontrib><creatorcontrib>Nottin, Stéphane</creatorcontrib><creatorcontrib>Benamor, Asma</creatorcontrib><creatorcontrib>Barthez, Olivier</creatorcontrib><creatorcontrib>Aboukhoudir, Falah</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Journal of the American Society of Echocardiography</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Philouze, Clothilde</au><au>Obert, Philippe</au><au>Nottin, Stéphane</au><au>Benamor, Asma</au><au>Barthez, Olivier</au><au>Aboukhoudir, Falah</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dobutamine Stress Echocardiography Unmasks Early Left Ventricular Dysfunction in Asymptomatic Patients with Uncomplicated Type 2 Diabetes: A Comprehensive Two-Dimensional Speckle-Tracking Imaging Study</atitle><jtitle>Journal of the American Society of Echocardiography</jtitle><addtitle>J Am Soc Echocardiogr</addtitle><date>2018-05</date><risdate>2018</risdate><volume>31</volume><issue>5</issue><spage>587</spage><epage>597</epage><pages>587-597</pages><issn>0894-7317</issn><eissn>1097-6795</eissn><abstract>Discrepancies are present in the literature on resting myocardial mechanics in patients with uncomplicated type 2 diabetes mellitus (T2DM). Data are noticeably sparse regarding circumferential function and torsional mechanics. Resting deformation imaging may not be sensitive enough to detect subtle dysfunctions. The aim of this study was thus to comprehensively evaluate myocardial mechanics in patients with T2DM at rest and to investigate whether dobutamine stress echocardiography could unmask functional alterations that would remain otherwise subtle at rest.
Forty-four patients with T2DM and 35 healthy control subjects of similar age and sex were prospectively recruited. After conventional echocardiography, myocardial mechanics was evaluated at rest and during low-dose dobutamine stress echocardiography (target heart rate, 110 beats/min).
Patients with T2DM presented with altered global diastolic function but preserved systolic function. Deformation imaging indexes were similar between groups at rest, but significant differences were noticed under dobutamine infusion for longitudinal strain (−21.2 ± 2.4% vs −24.2 ± 2.5%, P < .001), circumferential strain (apex, −32.3 ± 5.3% vs −36.3 ± 5.3%, P = .002; papillary muscle, −25.6 ± 3.2% vs −28.0 ± 3.6%, P = .001; base, −23.2 ± 3.6% vs −25.3 ± 3.8%, P = .03), apical (11.2 ± 4.4° vs 14.1 ± 6.3°, P = .020) and basal (−12.2 ± 3.3° vs −14.3 ± 3.9°, P = .021) rotation, and twist (21.9 ± 5.9° vs 26.8 ± 8.3°, P = .007). Multivariate analysis identified epicardial fat, dyslipidemia, and fasting glycaemia as significant contributors to the changes from rest to dobutamine.
These findings demonstrate the usefulness of dobutamine stress echocardiography in establishing impairments in myocardial mechanics in patients with uncomplicated T2DM. Systemic metabolic disturbances and epicardial fat act as the main contributors to the blunted response to dobutamine stress in these patients.
•Regional myocardial dysfunction is imperceptible at rest in patients with uncomplicated T2DM.•DB stress reveals early regional myocardial dysfunction and can serve as a diagnostic tool.•Cardiac functional reserve is lost in response to myocardial stress.•Factors responsible for the blunted myocardial response to β-adrenergic stimulation are delineated.•These findings enable better understanding of the central origin of exercise intolerance in patients with T2DM.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29526563</pmid><doi>10.1016/j.echo.2017.12.006</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-9557-1962</orcidid><orcidid>https://orcid.org/0000-0002-9065-9399</orcidid><orcidid>https://orcid.org/0000-0002-0669-0263</orcidid><orcidid>https://orcid.org/0000-0003-0472-6338</orcidid><orcidid>https://orcid.org/0000-0001-7797-1137</orcidid></addata></record> |
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| subjects | Asymptomatic patients Cardiology and cardiovascular system Dobutamine stress echocardiography Epicardial adipose tissue Human health and pathology Life Sciences Regional myocardial function Speckle-tracking imaging Uncomplicated type 2 diabetes |
| title | Dobutamine Stress Echocardiography Unmasks Early Left Ventricular Dysfunction in Asymptomatic Patients with Uncomplicated Type 2 Diabetes: A Comprehensive Two-Dimensional Speckle-Tracking Imaging Study |
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