Relationship between diabetic retinopathy and subclinical myocardial dysfunction in patients with diabetic mellitus

Abstract

BACKGROUND: Type 2 diabetes mellitus (T2DM) complicated by retinopathy is associated with impaired left ventricular (LV) structure and resting myocardial dysfunction. The myocardial response to stress has not been compared in patients with and without diabetic retinopathy. METHODS: A total of 134 parents with T2DM without any history of cardiovascular disease were recruited. All patients underwent detailed retinal photography to screen for diabetic retinopathy, resting and exercise echocardiography. Resting echocardiography was analysed by (1) conventional echocardiographic parameters and (2) speckle tracking derived global longitudinal strain (GLS). Exercise echocardiography parameters included diastolic function reserve index (DFRI) and stress GLS. RESULTS: A total of 43 (23%) patients had retinopathy. For resting echocardiography, both LV dimension and LV ejection fraction were similar between patients with and without diabetic retinopathy. However, patients with retinopathy had a significantly impaired GLS, higher prevalence of diastolic dysfunction, a higher E/E’ ratio (LV filling pressure) compared with patients without retinopathy. Stress echocardiography also showed that patients with diabetic retinopathy also had a more impaired DFRI and stress GLS. Multivariable analysis showed that the presence of diabetic retinopathy was independently associated with a higher resting E/E’, diastolic dysfunction grade, an impaired resting GLS, a low DFRI and impaired stress GLS. CONCLUSION: Patient with T2DM and retinopathy had impaired (i) resting myocardial function (diastolic function and GLS) and (ii) stress myocardial function (DFRI and ΔGLS) compared to those without retinopathy. Such data thus suggested that microvascular dysfunction contributed to both resting and stress myocardial dysfunction in patients with T2DM.