ABC | Volume 113, Nº2, August 2019

Original Article Presystolic Wave is Associated with Subclinical Left Ventricular Dysfunction Assessed by Myocardial Performance Index in Type 2 Diabetes Mellitus Selim Kul, 1 İhsan Dursun, 1 Semiha Ayhan, 2 Muhammet Rasit Sayin, 1 Özge Üçüncü, 2 Nilgün Esen Bülbül, 3 Ahmet Hakan Ateş, 4 Ali Rıza Akyüz 1 Trabzon Ahi Evren Gogus Kalp Ve Damar Cerrahisi Egitim Ve Arastirma Hastanesi – Cardiology, 1 Trabzon – Turkey Trabzon Kanuni Egitim Ve Arastirma Hastanesi – Endocrinology, 2 Trabzon – Turkey Trabzon Ahi Evren Gogus Kalp Ve Damar Cerrahisi Egitim Ve Arastirma Hastanesi - Internal Medicine, 3 Trabzon – Turkey Samsun Egitim ve Arastirma Hastanesi – Cardiology, 4 Samsun – Turkey Mailing Address: Selim Kul • Trabzon Ahi Evren Gogus Kalp Ve Damar Cerrahisi Egitim Ve Arastirma Hastanesi – Cardiology - Soğuksu Mahallesi Vatan Caddesi N°: 9 Ortahisar 61040, Trabzon, 61700 – Turkey E-mail: selimkul@gmail.com Manuscript received July 12, 2018, revised manuscript November 05, 2018, accepted November 14, 2018 DOI: 10.5935/abc.20190134 Abstract Background: Myocardial performance index (MPI), demonstrates both systolic and diastolic functions of the left ventricle. Presystolic wave (PSW) is frequently detected on Doppler examination of the left ventricular outflow tract and possible mechanism of PSW is impaired LV compliance and left ventricular stiffness. Objective: To investigate the relationship between PSW and MPI in type 2 diabetic patients. Method: A total of 129 type 2 diabetic patients were included in this study. Patients were divided into two groups according to the presence of PSW on Doppler echocardiography. There were 90 patients (38 male, mean age 57.77 ± 10.91 years) in the PSW-positive group and 39 patients (13 male; mean age: 55.31 ± 11.29 years) in the PSW-negative group. The p values of < 0.05 were considered statistically significant. Results: MPI was higher in PSW- positive group (0.63 ± 0.17vs 0.52 ± 0.13, p < 0.001). In addition, subclinical left ventricle dysfunction (LVD) was higher in the PSW- positive group (p = 0.029). Univariate analysis showed that the presence of PSW associated with abnormal MPI (p = 0.031). Pearson correlation analysis showed that PSW velocity correlated with MPI (r: 0.286, p = 0.006). Conclusion: Presence of the PSW on Doppler examination was associated with subclinical LV dysfunction in patients with DM type 2. This easy‑to-perform echocardiographic parameter may be related to subclinical LVD among patients with type 2 DM. (Arq Bras Cardiol. 2019; 113(2):207-215) Keywords: Heart/physiopathology; Diabetes Mellitus Type 2; Ventricular Dysfunction,Left; Heart Failure; Risk Factors. Introduction Diabetic cardiomyopathy is a common, albeit frequently missed, clinical entity affecting even asymptomatic patients with type 2 diabetes mellitus (DM). 1 These patients suffer excessive left ventricular (LV) enlargement, which starts as a normal functional consequence but later progresses to subclinical LV dysfunction (LVD). 2,3 Patients with type 2 DM actually suffer subclinical LVD at variable rates between 25% and 60%. 4-6 The earliest stages of diabetic cardiomyopathy are reportedly characterized by both subclinical LV systolic dysfunction (LVSD) and subclinical LV diastolic dysfunction (LVDD). 7-9 Importantly, the latest studies have indicated a continuum in the progress of subclinical LVD despite fine glycemic control over a period of 5 years. 10 This phenomenon may be indicative of a heightened risk of new-onset heart failure in even well-controlled type 2 DM. 11 First defined by Tei et al., 12 myocardial performance index (MPI) is a surrogate marker of both ventricular systolic and diastolic functions. Its utility has been investigated in a variety of cardiac conditions including myocardial infarction, hypertension (HT), diabetes, and heart failure, and an increased MPI is reportedly an ominous prognostic sign and independent predictor for morbidity and mortality. 13,14 A presystolic wave (PSW) is commonly found when the LV outflow tract (LVOT) is examined with the Doppler examination. 15 PSW may theoretically be associated with poor LV compliance and increased LV stiffness. 16,17 Given the hypothetical link between PSW and subclinical LVD in type 2 DM, we theorized that PSWmay be associated with subclinical LVD in patients with type 2 DM. 207