Long-term impact of diabetes on heart health - silent ventricular dysfunction

Medical News: A recent study conducted by researchers from the National Medical Research Center for Therapy and Preventive Medicine in Moscow, Russia, has shed new light on the long-term effects of type 2 diabetes (T2D) on heart health, specifically subclinical left ventricular dysfunction (LVD). This Medical News report dives into the key findings of the study, which followed patients over a seven-year period to assess how T2D impacts the heart in patients without any existing cardiovascular diseases (CVD). This article provides valuable insights for those looking to understand the often unnoticed cardiovascular risks posed by T2D.


Long-term impact of diabetes on heart health - silent ventricular dysfunction

In the study, led by Dr Dariga Uaydinichna Akasheva and her colleagues, 120 patients aged between 45 and 75 were assessed. The researchers aimed to identify structural and functional disorders in the heart's left ventricle (LV) among T2D patients over seven years. Of the original participants, 57 responded for follow-up, and the study provides valuable findings on how T2D can silently affect heart function.
 
Study Design and Methods
The study population consisted of two groups: one with T2D and a control group without diabetes. Participants underwent a series of medical tests, including transthoracic two-dimensional echocardiography, which allowed researchers to assess systolic and diastolic heart functions. Additionally, markers of carbohydrate metabolism such as NT-proBNP, and CRP were measured. These indicators are often used to evaluate heart health, and their fluctuation can indicate the development of cardiac issues.
 
The follow-up, which took place over seven years, allowed the researchers to observe changes in the participants’ heart function. Throughout the study, the aim was to understand how T2D, even in the absence of overt CVD, can lead to subclinical LVD, a condition where the heart's function declines without noticeable symptoms.
 
Key Findings: Subclinical Heart Dysfunction in T2D
One of the most significant findings was the rise in diastolic dysfunction (DD) among T2D patients. At the start of the study, 53% of patients with T2D had signs of DD, a condition where the heart's ability to relax and fill with blood is impaired. By the end of the seven-year follow-up, this percentage had risen to 61%. In contrast, no significant changes were observed in the control group.
 
The researchers also observed a marked increase in the incidence of reduced global longitudinal strain (GLS), a measure of heart muscle deformation during contraction. A decrease in GLS was noted in the T2D group, suggesting worsening heart function over time. The study found that GLS values dropped below the normal threshold (< -18%) in many patients, further highlighting the silent progression of heart disease in those with diabetes.
 
Diastolic Dysfunction and Its Implications
Diastolic dysfunction is one of the earliest indicators of heart problems, and the study found a clear link between T2D and worsening diastolic function. The E/A ratio, which is used to evaluate how well the heart fills with blood, decreased significantly in the T2D group, signaling that the heart's ability to relax was diminishing.
 
Interestingly, the study also found that concentric hypertrophy (thickening of the heart’s walls) became more prevalent in T2D patients. At the beginning of the study, 22% of patients had this condition, but after seven years, the number rose to 53%. This thickening can be a precursor to more serious heart issues, making it critical to monitor T2D patients closely.
 
What Drives the Changes in Heart Function?
The study identified several factors that contributed to the deterioration in heart function. Among T2D patients, elevated glucose levels, insulin resistance (measured by the HOMA index), and inflammation (indicated by higher CRP levels) were found to be independent predictors of heart dysfunction. These markers were closely linked to both diastolic dysfunction and reduced GLS.

Moreover, obesity was highlighted as a risk factor for worsening GLS, which suggests that T2D patients who are overweight or obese are at an even higher risk for developing heart problems.
 
Global Longitudinal Strain (GLS): A Key Indicator
Global longitudinal strain (GLS) is an essential tool in modern cardiology, and the study confirmed its importance in diagnosing early heart problems in T2D patients. Unlike traditional methods that rely on ejection fraction (EF), which measures how much blood the heart pumps out, GLS provides a more detailed view of the heart's muscle function. The study revealed that a significant number of T2D patients experienced a drop in GLS, even though their EF remained within normal ranges.
 
This decline in GLS underscores the silent nature of heart damage in T2D patients. Without regular monitoring using advanced echocardiography techniques, these early signs of heart dysfunction might go unnoticed until the patient develops more severe, symptomatic heart failure.
 
Conclusions: The Importance of Early Intervention
The findings of this study highlight the need for early detection and management of heart dysfunction in T2D patients. As the study shows, T2D is an independent risk factor for subclinical LVD, which can progress silently over time, eventually leading to symptomatic heart failure. Early recognition of diastolic dysfunction and monitoring of GLS can help identify high-risk patients before the condition becomes more serious.
 
For patients with T2D, regular heart monitoring, including advanced techniques like GLS measurement, could be crucial in preventing heart disease. Additionally, maintaining good control of blood sugar levels, managing weight, and reducing inflammation can help slow the progression of heart dysfunction.
 
In conclusion, this study emphasizes the importance of addressing heart health early in T2D patients, even if they don’t exhibit any cardiovascular symptoms. By doing so, healthcare providers can potentially delay or even prevent the onset of more serious heart conditions.
 
The study findings were published in the peer-reviewed journal: Biomedicines.
https://www.mdpi.com/2227-9059/12/9/2031
 
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