Echocardiographic evaluation of the effect of dapagliflozin on epicardial adipose tissue and left ventricular systolic function in type 2 diabetes mellitus.

BACKGROUND AND AIMS: Epicardial adipose tissue (EAT) is associated with cardiovascular disease, and sodium-glucose cotransporter-2 inhibitors (SGLT-2I) have been reported to reduce the occurrence of cardiovascular events. This study was designed to investigate the effect of an SGLT-2 inhibitor (dapagliflozin) on EAT and left ventricular (LV) systolic function in type 2 diabetes mellitus (T2DM) patients during a 6-month follow-up. METHODS: Twenty-seven T2DM patients who received dapagliflozin for the first time were enrolled in this study to measure EAT thickness and evaluate LV function before and after 6 months of SGLT-2 administration. The thickness of EAT was measured as the echo-free space between the free wall of the right ventricle and the visceral layer of the pericardium at end-systole by echocardiography. LV systolic function was evaluated by LV global longitudinal strain (LV GLS) obtained through two-dimensional speckle tracking echocardiography (2D-STE) technology. RESULTS: After a 6-month follow-up, twenty-five patients completed this study. The values of EAT thickness, HbA1c, body weight, body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly reduced, while the LV GLS value was significantly increased. Moreover, the increase in LV GLS was independently associated with the reduction in EAT thickness, HbA1c, weight, and SBP (all p < 0.05). CONCLUSIONS: Dapagliflozin can reduce EAT thickness and improve LV systolic function in T2DM patients. 2D-STE can be used for the early evaluation of the beneficial effect of dapagliflozin on LV systolic function. The improvement in LV systolic function is independently associated with a reduction in EAT thickness.

Echocardiographic Association of Epicardial Adipose Tissue with Ascending Aorta Elasticity in Patients with Type 2 Diabetes Mellitus.

Epicardial adipose tissue (EAT) is an emerging cardiovascular risk factor located between the myocardium and visceral pericardium. In order to investigate the association between EAT and ascending aorta elasticity in patients with type 2 diabetes mellitus (T2DM), we prospectively enrolled a total of 135 T2DM patients and 63 age- and gender-matched non-T2DM controls in this study. They all underwent transthoracic echocardiography to measure EAT thickness and ascending aorta inner diameters which were used to calculate ascending aorta elastic parameters: compliance (C), distensibility (D), strain (S), stiffness index (SI), and Peterson's elastic modulus (EM). We found that the values of C, D, and S were significantly lower, while SI, EM, and EAT thickness were significantly higher in T2DM patients compared with non-T2DM controls. Compared with T2DM patients with EAT < 5 mm group, C, D, and S were significantly reduced, SI and EM were significantly increased in T2DM patients with EAT ≥ 5 mm group (all P < .05). Bivariate correlation and multivariate linear regression analysis revealed that EAT was independently associated with ascending aorta elasticity. Our findings suggest that thickened EAT in patients with T2DM is associated with ascending aorta elasticity, independent of blood glucose.

Epicardial adipose tissue and right ventricular function in type 2 diabetes mellitus using two-dimensional speckle tracking echocardiography.

BACKGROUND: Epicardial adipose tissue is an emerging cardiovascular risk factor. The aim of this study was to evaluate right ventricular function and investigate its association with EAT in T2DM patients. METHODS: 154 T2DM patients were divided into two groups according to EAT thickness: T2DM with EAT <5 mm and T2DM with EAT ≥5 mm. Seventy non-T2DM patients were enrolled as control group. RV function was evaluated using both conventional echocardiography as well as two-dimensional speckle tracking echocardiography. EAT thickness was measured as the echo-free space between the free wall of the right ventricle and the visceral layer of pericardium at end-systole. RESULTS: Compared to control group, EAT thickness was significantly higher and RV systolic function and early diastolic function are all impaired in all T2DM patients. In T2DM with EAT ≥5 mm group, RV systolic function and early diastolic function suffered more severe impairment when compared with T2DM with EAT <5 mm group. Multivariate linear regression analysis revealed that EAT was associated with RV systolic and early diastolic dysfunction independent of traditional cardiovascular risk factors. CONCLUSIONS: Our research suggest that in T2DM patients RV systolic function and early diastolic function are all impaired which are associated with the thickened EAT.

Association between epicardial adipose tissue and left ventricular function in type 2 diabetes mellitus: Assessment using two-dimensional speckle tracking echocardiography.

BACKGROUND AND AIMS: Epicardial adipose tissue (EAT) is the visceral fat between the myocardium and the visceral pericardium. Dysfunctional EAT can cause cardiovascular diseases. The aim of this study was to investigate the association between EAT and left ventricular function in type 2 diabetes mellitus (T2DM) patients by two-dimensional speckle tracking echocardiography (2D-STE). METHODS: We prospectively enrolled 116 T2DM patients who were divided into two groups according to their left ventricular global longitudinal strain (GLS): 53 with GLS <18% and 63 with GLS ≥18%. The thickness of EAT was measured as the echo-free space between the free wall of the right ventricle and the visceral layer of pericardium at end-systole. LV systolic function was evaluated by GLS measured by 2D-STE. LV diastolic function was defined as the ratio of the early diastolic transmitral flow velocity (E) to average mitral annular velocity (e¯). RESULTS: Compared with patients with GLS ≥18% group, the age, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), glycosylated hemoglobinA1c (HbA1c), E/e¯, and thickness of EAT were higher in patients with GLS <18% group (all P < 0.05). Multivariate linear regression analysis revealed that the thickness of EAT was independently associated with left ventricular GLS and E/e¯. CONCLUSIONS: Thickened EAT is associated with impaired left ventricular function in T2DM patients. To investigate the association between EAT and left ventricular function can help us gain a deeper understanding of the pathogenesis of impaired cardiac function in T2DM patients.

Echocardiographic evaluation of the effect of poor blood glucose control on left ventricular function and ascending aorta elasticity.

BACKGROUND AND AIMS: Type 2 diabetes mellitus (T2DM) is associated with high cardiovascular risk. Preclinical left ventricular (LV) dysfunction and subclinical arterial stiffness have been documented in patients with T2DM. The aims of this study were to investigate whether there were any differences in LV function and ascending aorta elasticity between T2DM patients with controlled [defined as glycosylated hemoglobin (HbA1c) <6.5%] and uncontrolled (HbA1c ≥6.5%) blood glucose. METHODS: We studied 86 T2DM patients: 42 T2DM patients with controlled blood glucose (controlled T2DM group) and 44 T2DM patients with uncontrolled blood glucose (uncontrolled T2DM group), and 40 healthy subjects as control. They all underwent transthoracic echocardiography examination, LV systolic function was evaluated by global longitudinal strain (GLS) and LV diastolic function was defined as the ratio of the early diastolic transmitral flow velocity (E) to average mitral annular velocity (e¯). Ascending aorta inner diameters and brachial blood pressure were measured to calculate ascending aorta elastic parameters: compliance (C), distensibility (D), strain (S), stiffness index (SI), Peterson's elastic modulus (EM). RESULTS: Compared to control, T2DM patients had reduced GLS, increased E/e ̅ and impaired ascending aorta elasticity. Furthermore, LV function and ascending aorta elasticity were more severely damaged in uncontrolled T2DM group compared with controlled T2DM group. By Pearson correlation analysis, the level of HbA1c was independently associated with the parameters of the LV function and ascending aorta elasticity. CONCLUSIONS: T2DM can impair the LV myocardial function and ascending aorta elastic properties, which may be further impaired by poor blood glucose control.

Value of quantitative analysis of left ventricular systolic function in patients on maintenance hemodialysis based on myocardial work technique.

BACKGROUND: This study aimed to determine the left ventricular (LV) systolic function in patients on maintenance hemodialysis (MHD) using the myocardial work (MW) technique and investigate the clinical value of the MW technique for the quantitative analysis of left ventricular (LV) systolic function in MHD patients with left ventricular hypertrophy (LVH). METHODS: A total of 68 MHD patients and 35 controls were registered in this study. The MHD patients were divided into the non-left ventricular hypertrophy (NLVH) group (n = 35) and the LVH group (n = 33) according to the LV mass index (LVMI). MW was used to generate the LV global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), and global wasted work (GWW), global work efficiency (GWE). GLS and the MW parameters (GWI, GCW, GWW, GWE) were compared between groups and the correlations between these parameters and the LV ejection fraction (LVEF) in the LVH group were examined. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of MW parameters and GLS for the assessment of LV systolic dysfunction in MHD with LVH patients. RESULTS: The LVH group had significantly lower GWE, GWI, GCW, and GLS but higher GWW than the control and NLVH groups. Compared with the control group, the NLVH group had significantly lower GWE and GLS and higher GWW, but no significant differences in GWI, GCW were observed between these two groups. The LVEF was negatively correlated with GWW in MHD patients, but positively correlated with GWI, GWE, and GCW in the LVH group. Receiver operating characteristic curve (ROC) analysis revealed that GWE, GWW, GWI, and GCW had appreciable area under the curve (AUC), sensitivity, and specificity for evaluating LV function in LVH patients on MHD. CONCLUSIONS: The MW parameters can quantitatively represent the LV myocardial work in MHD patients. Thus, the technique provides a new method for the quantitative evaluation of LV systolic function in MHD with LVH patients.

Echocardiographic evaluation of the elasticity of the ascending aorta in patients with essential hypertension.

BACKGROUND: Hypertension is the most common chronic disease and the most important risk factor for cardiovascular and cerebrovascular diseases. Atheroma and arteriosclerosis plays a key role in the occurrence and development of hypertension. The purpose of this study was to evaluate the elasticity of ascending aorta wall in patients with essential hypertension (EH) using M-mode echocardiography. MATERIALS AND METHODS: We prospectively enrolled 54 EH patients and 51 healthy subjects (HS). They all underwent transthoracic echocardiography to measure ascending aorta inner diameters and brachial blood pressure measurement to calculate aortic elastic variables: compliance, distensibility, strain, stiffness index, and Peterson's elastic modulus. All participants also underwent bilateral carotid ultrasonographic examination. RESULTS: There were no significant differences in age, sex, body mass index, blood lipids, blood glucose, and ascending aorta inner diameters between the two groups. We found neither intimal thickening nor plaque formation in the left or right carotid arteries in both groups. The aortic elastic properties were significantly impaired in EH patients compared with HS. CONCLUSIONS: Echocardiography can be used for the noninvasive evaluation of ascending aorta wall elasticity as an early screening technique. Subclinical arteriosclerosis appeared to occur in the ascending aorta of patients with essential hypertension even though carotid ultrasonography was normal.

Evaluation of the Effect of Essential Hypertension on Elasticity of Ascending Aorta in Type 2 Diabetic Mellitus Patients by Echocardiography.

Both essential hypertension (EH) and type 2 diabetes mellitus (T2DM) can impair the elasticity of the ascending aorta. We prospectively enrolled 42 patients with T2DM, 44 patients with EH, 45 patients with T2DM and EH (T2DM + EH), and 41 healthy subjects (HS). They all underwent transthoracic echocardiography to measure ascending aorta inner diameters and a brachial blood pressure measurement to calculate aortic elastic parameters (ie, compliance, distensibility, strain, stiffness index, and Peterson elastic modulus). We found that there were no significant differences as regard with age, sex, body mass index, blood lipids and glucose, carotid atherosclerosis, and ascending aorta inner diameters among the 4 groups. The aortic elastic properties were significantly impaired in T2DM, EH, and T2DM + EH patients compared with the HS, and more impaired in EH and T2DM + EH patients than T2DM patients; there were no significant differences between EH and T2DM + EH patients. Our findings suggest that both T2DM and EH can impair aortic elastic properties. Essential hypertension may play a more important role in the process of ascending aorta sclerosis in patients with T2DM + EH.

Peak systolic longitudinal rotation: a new tool for detecting left ventricular systolic function in patients with type 2 diabetes mellitus by two-dimensional speckle tracking echocardiography.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is one of the most prevalent cardiac and cerebrovascular risk factors. The study aimed to find a new way to investigate left ventricle (LV) systolic dysfunction in T2DM patients using two-dimensional speckle tracking echocardiography (2D-STE). METHODS: Fifty-one untreated T2DM patients and 52 normal control subjects were enrolled for the research. Apical four-chamber view was acquired by two-dimensional echocardiography. Segmental and global peak systolic longitudinal rotation (PSLR) degrees were measured by the software of EchoPAC. RESULTS: In T2DM patients, global PSLR prominently rotated clockwise, while in normal subjects, global PSLR degrees were so small and almost had no PSLR. HBA1c negatively correlated with apex and global PSLR, that is, T2DM patients with higher HBA1c had a larger clockwise apex and global PSLR. ROC analysis showed that PSLR could detect the accuracy of LV systolic dysfunction. CONCLUSION: Cardiac clockwise global PSLR was found in T2DM patients. The cardiac contractile function in T2DM patients was impaired. The new tool of PSLR can conveniently detect cardiac systolic dysfunction in T2DM patients. HBA1c could predict systolic dysfunction in T2DM patients.

Left ventricular short-axis systolic function changes in patients with hypertrophic cardiomyopathy detected by two-dimensional speckle tracking imaging.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a genetic disease was characterised by left ventricular hypertrophy (LVH), myocardial fibrosis, fiber disarray. The short-axis systolic function is important in left ventricle function. METHODS: Forty one healthy subjects and 37 HCM patients were enrolled for this research. Parasternal short-axis at the basal, middle, and apical levels were acquired by Echocardiography. The peak systolic circumferential strain of the endocardial, the middle and the epicardial layers, the peak systolic radial strain, and the peak systolic rotational degrees at different short-axis levels were measured by 2-dimensional speckle tracking imaging (2D-STI). RESULTS: The peak systolic circumferential strain of the septum and anterior walls in HCM patients was significantly lower than normal subjects. All of the peak systolic radial strain in HCM patients was significantly lower than normal subjects. The rotational degrees at the base and middle short-axis levels in HCM patients were larger than normal subjects. The interventricular septal thickness in end-diastolic period correlated to the peak systolic circumferential strain of the septum wall. CONCLUSIONS: The short-axis systolic function was impaired in HCM patients. The peak circumferential systolic strain of the different layers, peak systolic radial strain and rotation degrees of the different short-axis levels detected by 2D-STI are very feasible for assessing the short-axis function in HCM patients.

Assessment of left atrial function in patients with hypertrophic cardiomyopathy using two-dimensional strain: a comparison with volume-derived values.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a common heart disease. Left atrial (LA) function plays an important role in the diastolic function in patients with HCM. In this study, two-dimensional speckle tracking imaging (2D-STI) was used to assess left atrial (LA) function in patients with HCM. METHODS: Thirty-four patients with HCM and thirty-four age- and gender-matched normal subjects were studied. The LA Volume-Derived Index was measured using 2D ultrasonic images. The LA strain (S-reservoir, S-conduit, S-booster pump) and the strain rate (SR-reservoir, SR-conduit, SR-booster pump), representing the reservoir, conduit and booster pump functions, respectively, were measured. RESULTS: The LA reservoir, conduit and booster pump functions were significantly different between patients with HCM and normal subjects. The values in patients with HCM were less than those in normal subjects. In patients with HCM, S-reservoir and SR-reservoir were significantly correlated with the total LA ejection fraction (LAEF), LA Expansion Index and left ventricular (LV) global longitudinal strain. S-conduit and SR-conduit were significantly correlated with e' and LV global longitudinal strain. S-booster pump and SR-booster pump were significantly correlated with the A, a', active LAEF and LA Expansion Index. S-booster pump was significantly correlated with the LV global longitudinal strain. CONCLUSIONS: 2D-STI conveniently demonstrated the LA dysfunction in patients with HCM by detecting the LA strain and strain rate. The accurate assessment of LA function could have potential clinical value for the treatment of patients with HCM.

Longitudinal rotation: a new way to detect the cardiotoxicity of anthracycline-based chemotherapy in breast cancer patients.

BACKGROUND AND AIMS: The study was to compare cardiac parameters before and after anthracycline-based chemotherapy and identify a parameter for detecting cardiotoxicity in breast cancer patients. METHODS: Cardiac function in 43 female breast cancer patients was evaluated at three time points: baseline, 1-3 days before the initiation of anthracycline-based chemotherapy; 3 weeks and 6 months after the final cycle of chemotherapy. At each visit, the peak longitudinal velocity; strain rate; peak systolic strain; peak systolic longitudinal displacement, and segmental and global longitudinal rotation degrees of the left ventricular were measured. RESULTS: The peak early-diastole left ventricular wall velocity at baseline was significantly higher than the values at 3 weeks and 6 months after the final cycle of chemotherapy. The absolute value of the lateral wall peak systolic longitudinal rotation degrees was significantly higher at baseline than at 3 weeks and 6 months after the final cycle of chemotherapy, whereas the absolute value of the global peak systolic longitudinal rotation degrees at baseline was significantly lower than the values at 3 weeks and 6 months after the final cycle of chemotherapy. None of the measured parameters differed significantly between the 3 weeks and 6 months after the final cycle of chemotherapy. CONCLUSIONS: Cardiac diastolic and systolic dysfunction was found after anthracycline-based chemotherapy in this study, and the peak systolic longitudinal rotation degrees can be used to detect dysfunction after chemotherapy. The cardiotoxicity of epirubicin-based chemotherapy is stronger than that of therarubicin-based chemotherapy.

Left ventricular systolic function changes in hypertrophic cardiomyopathy patients detected by the strain of different myocardium layers and longitudinal rotation.

BACKGROUND: Impairment of left ventricular (LV) longitudinal function has an important role in hypertrophic cardiomyopathy (HCM). This research investigated an association between the longitudinal strain of different myocardial layers, longitudinal rotation and the LV systolic function of HCM patients. METHODS: The research was performed on 36 HCM patients and 36 healthy subjects. The peak systolic longitudinal strain of the subendocardial, midmyocardial, and subepicardial layers was measured using 2-dimensional speckle tracking echocardiography (2D-STE). The apical long-axis and 4- and 2- chamber views were acquired via 2D Doppler echocardiography. The curve of the longitudinal rotation was traced at 17 timepoints in the analysis of 2 cardiac cycles. RESULTS: Compared with healthy subjects, in HCM patients regional LV peak systolic longitudinal strain was less, not only in hypertrophied LV myocardium, but also in non-hypertrophied myocardium. The rotational degrees of the midmyocardial-septal, apex, and lateral wall of HCM patients were significantly different from that of normal subjects, as follows. In HCM patients, clockwise longitudinal rotation was found. The interventricular septum thickness at end-diastole positively correlated with the peak longitudinal systolic strain of the subendocardial, the midmyocardial, and the subepicardial layers. The area under ROC curve values for subendocardial, midmyocardial and subepicardial layers in HCM patients were 0.923, 0.938, 0.948. CONCLUSION: In HCM patients, the longitudinal function was damaged, even with normal LV ejection fraction. The peak longitudinal systolic strain of the subendocardial, midmyocardial, and subepicardial layers, and the longitudinal rotation detected by 2D-STE, are very sensitive predictors of systolic function in patients with HCM.

Left ventricular longitudinal function assessment in rabbits after acute occlusion of left anterior descending coronary artery by two-dimensional speckle tracking imaging.

ABSTACT: BACKGROUND: To evaluate the left ventricular (LV) longitudinal function changes in rabbits after acute occlusion of the left anterior descending artery (LAD) by two-dimensional speckle tracking imaging (2D-STI). METHODS: Forty-eight New Zealand white rabbits underwent echocardiography examination. EchoPAC was used to measure LV peak systolic longitudinal strain (LS) of the endocardium, middle myocardium, and epicardium, peak longitudinal strain rate (LSr), segmental and global longitudinal rotation (LR) degrees. Ligated the LAD and repeated all measurements after 10 min. RESULTS: Peak LS and LSr were significantly different between the preoperative and postoperative rabbits among most LV walls (P < 0.05). In apical four-chamber view, there was significant difference in the degrees of rotation of the LV lateral wall in preoperative and postoperative rabbits (P < 0.05). In apical three-chamber view, the rotation degrees of the posterior wall and the LR were significantly lower in the postoperative than in the preoperative (P < 0.001). In apical two-chamber view, the rotation degrees of the inferior wall and the LR were significantly lower in the postoperative (P < 0.05). CONCLUSIONS: Left ventricular function was impaired after acute occlusion of LAD. Segmental rotational degrees and changes in LR could be useful indicators of cardiac function during the early phases of acute myocardial ischemia.

Left Ventricular Systolic Function Changes in Primary Hypertension Patients Detected by the Strain of Different Myocardium Layers.

This study investigated left ventricular (LV) systolic dysfunction associated with differential strain among myocardial layers in primary hypertension (PH) patients with or without LV hypertrophy (LVH), and normal patients.In 63 PH and 42 healthy patients, two-dimensional speckle tracking echocardiography was used to measure the peak systolic longitudinal and circumferential strain of the myocardial subendocardial, middle and subepicardial layers, and the peak systolic radial strain. To assess LV systolic function, the apical long axis, 4- and 2-chamber views, and parasternal short axis at the basal, middle, and apical levels were acquired by cardiovascular ultrasound (Vivid E9, GE Healthcare, USA).Overall, the pattern in peak systolic longitudinal strain among myocardial layers was subendocardial > middle > subepicardial. In the peak systolic circumferential strain, this was middle > subepicardial > subendocardial. The peak systolic longitudinal strain was normal > NLVH > LVH. Among the groups, the peak systolic circumferential strain at the basal parasternal short-axis level was statistically similar, but at the middle and the apical parasternal short-axis levels were NLVH > normal > LVH. In normal and NLVH patients, the peak radial strain was middle > apical > basal, and in LVH patients was apical > middle > basal. The peak averages of the longitudinal and subendocardial circumferential strains differed significantly when LVH compared with NLVH and normal patients.The systolic function of PH patients was damaged in comparison with normal individuals, which could be detected conveniently and accurately using two-dimensional speckle tracking echocardiography.