Asymptomatic left ventricular dysfunction in patients with type 2 diabetes free of cardiovascular disease and its relationship with clinical characteristics: The DIACAR cohort study

Aims Type 2 diabetes mellitus (T2DM) is associated with high risk of heart failure. Several studies have reported asymptomatic left ventricular dysfunction (LVD) in T2DM patients with normal ejection fraction. Purpose of our study was to assess the prevalence, the type and clinical factors associated with LVD in T2DM patients by a comprehensive echocardiographic Doppler assessment including speckle tracking. Methods 200 T2DM patients without overt cardio-vascular disease were prospectively enrolled in a single center cohort study between 2018 and 2019. Results LV mass was increased in 24 patients (12%) whereas relative wall thickness (h/r) was increased in 46 patients (23%). Left atrial (LA) enlargement was observed in 27 patients (13.6%) and global longitudinal strain (GLS) was reduced in 38 patients (20.3%). By univariate analysis, LV hypertrophy or increased h/r were associated with age, renal function, hypertension and B type natriuretic peptide plasma level (BNP). LA dilation was associated with age, history of hypertension, diabetes duration and complications, insulin treatment, BNP and renal function. GLS was associated with body mass index (BMI) and in a borderline manner with diabetes duration. By multivariate analysis, hypertension was associated with LVH, and with h/r and a borderline relationship was observed for female gender (LVH) age and insulin treatment (h/r). Age, hypertension and in a borderline manner insulin treatment were associated with LA dilation. BMI and shorter diabetes duration were associated with reduced GLS. Conclusion/interpretation A high prevalence of asymptomatic cardiac dysfunction/structural abnormalities is observed in T2DM without overt cardiac disease and is associated with either age, diabetes duration or treatment and with comorbidities including hypertension and obesity. Whether these preclinical abnormalities are associated with poor outcomes deserves further studies. This article is protected by copyright. All rights reserved.