An increased burden of microvascular complications is independently associated with reduced global longitudinal strain (GLS) in asymptomatic diabetes mellitus (DM) and nonobstructive coronary artery disease, according to a study published in BMC Cardiovascular Disorders.

In this cross-sectional, single-center study, patients aged ≥18 years with a verified diagnosis of DM were examined with 2D transthoracic echocardiography, coronary computed tomography angiography, electrocardiography, blood pressure measurements, clinical review, and bloodwork. Microvascular complications such as albuminuria, retinopathy and peripheral neuropathy were obtained from the Funen Diabetes Database. GLS was assessed using automated function imaging in EchoPAC software.

The number of microvascular complications was associated with increasing plaque burden (β 2.97; 95% CI, 0.42-5.51; P =.02). Patients with type 2 DM had significantly reduced GLS compared with patients with type 1 diabetes in the univariable linear regression model (β 1.30; 95% CI, 0.50-2.11, P =.01). An increasing number of microvascular complications was associated with reduced GLS (β 0.71; 95% CI, 0.59-0.82).

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This study is potentially limited by the selection of patients due to missing data on the GLS. The majority of patients had type 2 diabetes; therefore, the findings could be driven by patients in this population. “In this study, an association between an increased number of microvascular complications and reduced GLS was observed,” the researchers concluded. “Previous studies have investigated the impact of an increasing number of microvascular complications and GLS and detected a significant association. Of the microvascular complications, albuminuria has been investigated extensively in patients with DM and albuminuria was associated with reduced left ventricle (LV) systolic function, including GLS. Retinopathy and peripheral neuropathy have also been investigated and are also observed to occur with reduced LV systolic function.”


Pararajasingam G, Laurits HJ, Larsson J, et al. Diabetic microvascular complications are associated with reduced global longitudinal strain independent of atherosclerotic coronary artery disease in asymptomatic patients with diabetes mellitus: a cross-sectional study. BMC Cardiovasc Disord. 2021;21:269.