Diabetic cardiomyopathy: Pathophysiology, theories and evidence to date

Table 3 Studies on left ventricular function and myocardial strain in diabetes

Publication and imaging modality	Group and baseline characteristics	Exclusion	Main findings
Ernande et al[107], 2010	T2DM: n = 119, 69 males	LVEF < 56%, age < 35 or > 65, signs, symptoms or history of heart disease, no RWMA, valve disease, renal disease, T1DM, poor DM control (HbA1C > 12%)	↓GLS (-19.3% ± 3% vs -22% ± 2%) and GRS (50% ± 16% vs 56% ± 12%, nP < 0.003) in participants with diabetes vs participants without diabetes
Echocardiography	Controls: n = 39, 30 males		Multivariate analysis showed DM (t = 3.9, P < 0.001) and gender (t = 3.4, P = 0.001) independent determinants of GLS, DM only independent determinant of GRS.
Ng et al[91], 2012	n = 69	Age < 18 yr, arrhythmia, CAD, MI, RWMA, segmental LGE, EF < 50%, valve disease	↓GLS DM vs controls (-16.1% ± 1.4% vs 20.2% ± 1.0% pP < 0.001)
MRI	DMs (n = 50, 35 T1DM) Mean age 51 ± 10 yr, 54% males. BMI 26.3 ± 3.7		↓GLS DM T2DM vs T1DM (-15.3% ± 1.2% vs 16.4% ± 1.4%, qP = 0.009)
	Controls (n = 19), matched for age (45 ± 15), sex (63.2% males) an BMI 26.1 ± 4.4
Khan et al[11], 2014	T2D n = 20, Mean age 31.8 ± 6.6, BMI 33.9 ± 5.8 kg/m2	Weight > 150 kg, contraindications to MRI. In diabetic group BMI > 30 (> 27.5 in South Asians)	↓PEDSR in DMs vs Lean controls vs obese controls (1.51 ± 0.24 vs 1.97 ± 0.34 vs 1.78 ± 0.39 s-1) and PSSR (-21.20 ± 2.75 vs -23.48 ± 2.36 vs -23.3 ± 2.62s-1)
MRI	Lean Controls: n = 10, Mean age 30.9 ± 5.6, Mean BMI 33.4 ± 2.4, 60% males.
	Obese controls: n = 10, Mean age 30.0 ± 6.7, Mean BMI 21.9 ± 1.7, 50% males
Levelt et al[62], 2016	T2D: n = 39, Mean age 55 ± 9, 58% males.	History of CVD, chest pain, smoker, uncontrolled hypertension, contraindications to MRI, ischaemia on ECG, renal dysfunction, insulin use, significant CAD on CTCA	↓GLS (-9.6 ± 2.9 vs -11.4 ± 2.8 rP = 0.049) and  mid ventricular (-14.2 ± 2 vs -19.3, sP < 0.001) systolic strain (PCr/ATP ratio at rest and exercise, correlated with reduced systolic strain results; there was also a negative association between the myocardial lipid levels and systolic strain in this cohort)
MRI	Controls: n = 17, Mean age 50 ± 14 yr

CTCA: Computed topography coronary angiogram; GLS: Global longitudinal strain; GRS: Global radial strain; PEDSR: Peak early diastolic strain rate; PSSR: Peak systolic strain rate; RWMA: Regional wall motion abnormality.