Relationship of left ventricular longitudinal strain to coronary artery calcium load in patients with newly diagnosed type 2 diabetes mellitus
Authors: Bakalli A , Hyseni V , Krasniqi X , Gjikolli B , Elezi S 
Published: January 2025

Abstract

Introduction
Cardiovascular complications commonly manifest after longstanding Type 2 Diabetes Mellitus. Newly diagnosed Type 2 Diabetes Mellitus (NDT2DM) is much less studied. The coronary artery computed tomography calcium score (CTCS) has become a widely accessible, accurate, and reliable tool for assessing the risk of major cardiovascular events, particularly in asymptomatic individuals. Additionally, myocardial strain, specifically echocardiographic Global Longitudinal Strain (GLS), measures the systolic function of the left ventricle (LV), enabling the early detection of systolic dysfunction. GLS is also increasingly recognized for its prognostic value in coronary artery disease.

Purpose
The objective of this study was to analyze the relationship and predictors of subclinical calcified atherosclerotic plaques in coronary arteries, measured by CTCS, to LV longitudinal strain in patients with NDT2DM.

Methods
In this prospective cross-sectional study 101 patients with NDT2DM, according to the criteria of the American Diabetes Association, were included. CTCS was performed on all patients by 64-slice cardiac CT, with a thickness of 2-5 mm. The Agatston method was used to determine the CTCS. For Speckle Tracking Echocardiography, images from the apical four-chamber, three-chamber and two-chamber views with ECG gating were attained. The endocardial border was manually adjusted at end-systole. The software system automatically generated the strain values for each segment, the average LV GLS, end-diastolic, end-systolic LV volumes and LV ejection fraction. With Spearman’s correlation test we analysed the relationship between LV longitudinal strain parameters and the level of CTCS. We also performed the multiple regression analysis to identify LV longitudinal strain predictors for high CTCS.

Results
Mean age was 54.4 ± 11.6 years, 53 (52.5%) were males, and mean time since diagnosis of diabetes was 2.8 ± 5.3 months. Only 8 (7.9%) patients did not have calcified atherosclerotic plaques or a CTCS of zero, 7 (6.9%) a CTCS of 1-10, 43 (42.6%) a CTCS of 11-100, 23 (22.8%) a CTCS 101-400 and 20 (19.8%) patients had CTCS &gt;400. The mean total volume of calcium in these patients was 210. LAD had the highest CTCS, followed by RCA, LCx and left main coronary artery. Table 1 shows the correlation between CTCS and LV longitudinal strain parameters, while table 2 depicts predictors for higher CTCS.

Conclusions
LVGLS does not appear to correlate with the coronary artery calcium burden in patients with NDT2DM. However, regional LV longitudinal strain may serve as a predictor for asymptomatic calcified coronary artery plaques. Given that the LAD exhibits the highest CTCS, the predictive regions might correspond to this affected artery. Thus, a comprehensive analysis of both global and regional LV longitudinal strain could be beneficial for the early detection of patients at risk for cardiovascular complications.
Correlation of CTCS and LV strain
LV strain predictors for CTCS