Association between Newly Diagnosed Type 2 Diabetes Mellitus and Left Ventricular Global Longitudinal Strain: A Single Center, Cross-Sectional Study

Objective: Diabetes mellitus is a major cardiovascular risk factor. Diabetic complications in the cardiovascular system randomly appear following long standing diabetes. However, newly diagnosed diabetes can also be associated with cardiac problems. The aim of this study was to compare patients with newly diagnosed type 2 diabetes mellitus (T2DM) to healthy controls in regard to echocardiography features, specifically left ventricular global longitudinal strain (LV GLS). Materials and methods: This was a prospective crosssectional study conducted on 94 patients, 52 patients with newly diagnosed T2DM that formed the first group and 42 healthy subjects, without history of diabetes mellitus and/or cardiovascular disease, which formed the second group. Results: Patients with newly diagnosed T2DM had mean glucose level of 16.37 ± 7.43 mmol/L and HbA1c of 8.57 ± 2.31 %. The groups did not differ in regard to age, gender, smoking, arterial hypertension or heart rate at the time of examination. The ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) of the septal wall was significantly lower in patients with newly diagnosed T2DM (6.21 ± 3.14 vs. 7.8 ± 2.45, p = 0.009). The LV GLS resulted lower in patients with newly diagnosed T2DM compared to the healthy subjects (|–19.36|% ± 2.98 vs. |–20.43|% ± 1.99. p = 0.049). Of note, the LV GLS values are expressed as absolute numbers. The ratio of patients with LV GLS strain < |–18.8|% was significantly higher in patients with newly diagnosed T2DM (42.31% vs. 21.43%, p = 0.03). Conclusions: LV GLS may serve as an important echocardiographic parameter to detect early myocardial changes in asymptomatic patients with newly diagnosed T2DM

Use of the “Minnesota Living with Heart Failure Questionnaire” Quality of Life Questionnaire in Kosovo’s Heart Failure Patients

Background: Quality of life (QoL) is one of the most important end-points in heart failure (HF) patients. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is the most widely used measurement for assessing the QoL in HF patients. This questionnaire had been translated and validated into the Albanian language. We used this questionnaire to evaluate the QoL in HF patients in Kosovo. Methods The study subjects were 103 consecutive HF patients (63±10 years, 56 female, 48% hypertensive and 26% ischaemic etiology, classified as NYHA I-III) admitted in outpatient or in-patient clinics at University Clinical Centre of Kosovo. At the moment of evaluation the patients were clinically stable and on optimized drug therapy. Relationships were tested between questionnaire score and different clinical and demographic factors. Results There was no difficulty in the administration of the Albanian version of MLHFQ or in the patient’s understanding of the questions. The overall median score of MLHFQ was 51 (mean 50±18). Female patients had higher total (p=0.015), emotional (p=0.022) and physical (p=0.019) MLWH compared to male patients. Te total MQLQ score had good correlation with 6MWT distance (p<0.001), but not with the level of NTproBNP level (p=0.364).Significant relationship was found also between MLWH and NYHA functional class in HF patients (p=0.002 for total, p=0.026 for emotional, and p<0.001 for physical MLHF score). NYHA functional class also significantly correlated with 6MWT distance (p<0.001 for both). Conclusions The Albanian version of the MLHFQ proposed in this study proved to be valid for HF patients and served as a new and important instrument for assessing QoL in Kosovo’s patients. The MLHFQ was mildly higher in our patients compared with previous studies and was higher in female patients. The questionnaire score correlates with functional NYHA class, reflecting the severity of the disease, and with 6 minute walk test, reflecting exercise capacity

Left ventricular markers of global dyssynchrony predict limited exercise capacity in heart failure, but not in patients with preserved ejection fraction

Background: The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional capacity assessed by 6 min walk test (6-MWT) in patients with heart failure (HF), irrespective of ejection fraction (EF). Methods: In 147 HF patients (mean age 61 +/- 11 years, 50.3% male), a 6-MWT and an echo-Doppler study were performed in the same day. Global LV dyssynchrony was indirectly assessed by total isovolumic time - t-IVT [in s/min; calculated as: 60 - (total ejection time + total filling time)], and Tei index (t-IVT/ejection time). Patients were divided into two groups based on the 6-MWT distance (Group I: &lt;= 300 m and Group II: &gt; 300 m), and also in two groups according to EF (Group A: LVEF &gt;= 45% and Group B: LVEF &lt;45%). Results: In the cohort of patients as a whole, the 6-MWT correlated with t-IVT (r = -0.49, p &lt; 0.001) and Tei index (r = -0.43, p &lt; 0.001) but not with any of the other clinical or echocardiographic parameters. Group I had lower hemoglobin level (p = 0.02), lower EF (p = 0.003), larger left atrium (p = 0.02), thicker interventricular septum (p = 0.02), lower A wave (p = 0.01) and lateral wall late diastolic myocardial velocity a' (p = 0.047), longer isovolumic relaxation time (r = 0.003) and longer t-IVT (p = 0.03), compared with Group II. In the patients cohort as a whole, only t-IVT ratio [1.257 (1.071-1.476), p = 0.005], LV EF [0.947 (0.903-0.993), p = 0.02], and E/A ratio [0.553 (0.315-0.972), p = 0.04] independently predicted poor 6-MWT performance (&lt; 300 m) in multivariate analysis. None of the echocardiographic measurements predicted exercise tolerance in HFpEF. Conclusion: In patients with HF, the limited exercise capacity, assessed by 6-MWT, is related mostly to severity of global LV dyssynchrony, more than EF or raised filling pressures. The lack of exercise predictors in HFpEF reflects its multifactorial pathophysiology