Heightened Subclinical LV Dysfunction in Diabetics with Neuropathy: Cardiovascular MRI study provides insights

Using cardiovascular magnetic resonance imaging (MRI), researchers found that T2DM patients with DPN exhibited more pronounced subclinical left ventricular myocardial dysfunction than those without DPN. Key metrics, including LV radial and longitudinal peak strains and peak diastolic strain rates, were lower in DPN patients, indicating severe subclinical LV dysfunction. The findings were published online in

Cardiovascular Diabetology on June 24, 2024.

Diabetic peripheral neuropathy is a common complication of T2DM, characterized by nerve damage in the extremities due to prolonged exposure to high blood sugar levels. While the link between T2DM and cardiovascular disease is well-established, the study aimed to investigate the subclinical LV myocardial dysfunction in type 2 diabetes mellitus patients with and without DPN.

The study included one hundred and thirty T2DM patients without DPN, 61 patients with DPN, and 65 age and sex-matched controls who underwent CMR imaging. All subjects had no symptoms of heart failure and LV ejection fraction ≥ 50%.

Late gadolinium enhancement (LGE) imaging was used to identify non-infarct myocardial involvement in the left ventricle. CMR feature tracking was employed to assess LV global strains, including radial, circumferential, and longitudinal peak strain (PS), as well as peak systolic (PSSR) and diastolic (PDSR) strain rates. These parameters were compared across three groups. Multivariable linear regression analyses were conducted to identify the independent factors associated with reduced LV global myocardial strains in patients with T2DM.

The study led to the following findings:

· The prevalence of non-infarct LGE was higher in patients with DPN than those without DPN (37.7% versus 19.2%).

· The LV radial and longitudinal PS (radial: 36.60 ± 7.24% versus 33.57 ± 7.30% versus 30.72 ± 8.68%; longitudinal: − 15.03 ± 2.52% vs. − 13.39 ± 2.48% versus − 11.89 ± 3.02%), as well as longitudinal PDSR [0.89 1/s versus 0.80 1/s versus 0.77 1/s] were decreased significantly from controls through T2DM patients without DPN to patients with DPN.

· LV radial and circumferential PDSR, as well as circumferential PS were reduced in both patient groups but were not different between the two groups.

· Radial and longitudinal PSSR were decreased in patients with DPN but preserved in those without DPN.

· Multivariable linear regression analyses adjusting for confounders demonstrated that DPN was independently associated with LV radial and longitudinal PS (β = − 3.025 and 1.187, respectively) and PDSR (β = 0.283 and − 0.086, respectively), as well as radial PSSR (β = − 0.266).

The study revealed increased non-infarct LGE lesions and deteriorating subclinical LV function in type 2 diabetes patients with diabetic peripheral neuropathy compared to those without DPN. These findings highlight the potential for future prospective studies to explore more extensive therapeutic interventions in this patient group to enhance patient outcomes.

Reference:

Li, XM., Shi, K., Jiang, L. et al. Assessment of subclinical LV myocardial dysfunction in T2DM patients with diabetic peripheral neuropathy: a cardiovascular magnetic resonance study. Cardiovasc Diabetol 23, 217 (2024). https://doi.org/10.1186/s12933-024-02307-x