Impact of obesity on left ventricular geometry and function in type 2 diabetes mellitus patients

  AIM   To evaluate the impact of obesity on left ventricular geometry and functions in type 2 diabetes mellitus (T2DM) patients using conventional echocardiography and three-dimensional speckle tracking imaging and to explore the risk factors that could affect left ventricular strain values in these patients.

  METHODS   Ninety-five T2DM patients were divided into T2DM without obesity group (n=45, BMI<25 kg/m²) and T2DM with obesity group (n=50, BMI≥25 kg/m²). Thirty age-and-gender matched healthy volunteers were selected as the controls. Conventional echocardiography and three-dimensional speckle tracking imaging were performed for all participants.

  RESULTS   Significant differences in left ventricular geometry were found between the three groups (P<0.05). Compared with those in the controls, left ventricular remodeling was more prevalent in the T2DM patients and left ventricular hypertrophy was most prevalent in the T2DM with obesity group. Compared with those in the controls, e' in T2DM without obesity group was significantly lower (P<0.05) and E/e' was significantly increased (P<0.05). Both the left atrial volume index and E/e' in T2DM with obesity group were significantly increased (P<0.05), while e' was significantly decreased (P<0.05). Global longitudinal strain in T2DM without obesity group was significantly lower than that in the controls (P<0.05). The global longitudinal strain, global circumferential strain, global area strain, and global radial strain values in T2DM with obesity group were all significantly lower than those in the controls (all P<0.05) and were also significantly lower than those in T2DM without obesity group. Both HbA1c and BMI were independently associated with all strain values in patients with T2DM. RWT and LVMI had negative effects on some directions strain.

  CONCLUSION   Obesity may exacerbate left ventricular remodeling and left ventricular dysfunction in T2DM patients, and these subclinical left ventricular abnormalities with retained ejection fraction can be detected using conventional echocardiography and three-dimensional speckle-tracking imaging.