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From Affiliated Egyptian Universities and Cardiology Centers

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Background:Right ventricular dysfunction is relevant in a variety of disease states affecting both the course and prognosis of diabetes mellitus and therefore assessment of right ventricular performance is also an important issue in diabetic patients.
AIM: To diagnose early right ventricular systolic and diasolic dysfunction in type 2 diabetics by 3D and strain/strain rate imaging..
Methods: Groups studied consisted of 30 patients with type 2 diabetes only, no coexisting hypertension (DM; aged 56.6±12.4years). In all patients with diabetes, coronary artery disease and pulmonary hypertension were excluded. Thirty healthy age-matched persons served as control subjects. In each patient an 3D echocardiographic study with strain/strain rate imaging was performed. Analysis of RV deformation data included assessment of systolic strain, peak systolic strain rate and peak early diastolic strain rate obtained from the basal and apical segments of the RV free wall.
Results :Deterioration of right ventricular diastolic function was shown in type 2 diabetic group, which was indicated by TDI parameters (Significantly lower values of Em and Em-to-Am ratio in the basal and apical segments) and by significantly longer right ventricular IRT estimated from conventional Doppler.
Systolic strain, peak systolic strain rate and early diastolic SR of basal (−12±3% vs −24±5%, -1.28±0.3/s vs −1.9±0.4/s; 5.4±1.4 vs 8.6±1.7 respectively) and apical (−16±3% vs −26±4%, -1.2±0.3/s vs −2.1±0.3/s, 5.7±1.5 vs 8.4±1.8 respectively) segments of right ventricle were significantly lower in patients with type 2 diabetes than in controls.
Conclusions: The right ventricular Xechocardiographic dimension among studied groups showed no statistically significant difference (P >0.05), however the Mean ± SD of the right ventricular wall thickness was significantly higher among asthmatic children (1.4±0.72cm) than controls (0.8±0.26cm) (P <0.001). Tissue doppler study of the right ventricular diastolic function revealed that peak E′ velocity, peak A′ velocity, E′/A′ ratio and isovolumetric relaxation time (IVRT) of the lateral tricuspid annulus, were significantly different among asthmatic patients (10.08±2.8cm/sec, 5.7±2.5cm/sec, 1.77±0.58 and 128.9±30.7m/sec respectively) compared to control subjects (12.4±2.3cm/sec, 7.8±2.1cm/sec, 1.58±0.32 and 91.1±32.6m/sec respectively). Also E′ velocity and IVRT of the lateral tricuspid annulus were significantly different between mild, moderate and severe cases (P <0.001) respectively.
cONCLUSIONS:Type 2 diabetis mellitus is commonly associated with right ventricular systolic and diastolic dysfunction which should be screened in each diabetic patient.
Keywords: Right ventricle, Diabetes mellitus, 3 dimensional.