Cardiology and Cardiovascular Research

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Assessment of Left Ventricular Functions in Hypertensive Diabetic Patients by Speckle Tracking Imaging: Correlation with Brain Natriuretic Peptide Levels

Received: 24 July 2020    Accepted: 10 August 2020    Published: 18 August 2020
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Abstract

Background: Hypertension and diabetes are major contributors to structural changes including myocardial fibrosis and progressive alteration of LV systolic and diastolic functions. Two-dimensional speckle tracking echocardiography is a reliable imaging modality that overcomes the limitations of Tissue Doppler imaging and allows a more accurate assessment of myocardial deformation at the global and regional levels. Objectives: The investigation aims to assess Left Ventricular functions in patients with hypertension and/or diabetes who have apparently preserved LV systolic function; using speckle tracking echocardiography, and correlate the findings with plasma Brain Natriuretic Peptide levels. Methods: Twenty healthy subjects were enrolled as a control group. Sixty patients with hypertension and/or diabetes were recruited and assembled as three equal groups, hypertensives, diabetics, and hypertensive-diabetics. 2D-STE was performed to assess LV longitudinal strain and strain rate. Plasma BNP levels were measured for all subjects. Results: Global systolic longitudinal strain was significantly reduced in patients compared to controls (P=0.001). It was more reduced in group 4. Global systolic SR was reduced in patients compared to controls, being more significantly reduced in groups 2 and 4 (P=0.001). Global early diastolic SR was reduced in patients compared to controls (P=0.001). Meanwhile, Global late diastolic SR values were higher among patients, especially groups 2 and 4 (P=0.001). BNP levels were significantly higher in group 4 compared to group 1 (P=0.000), group 2 (P=0.000), and group 3 (P=0.000). BNP levels and global systolic strain in group 4 were significantly correlated. Conclusion: LV systolic dysfunction was found among all patients groups, confirmed by the significant reduction in LV global longitudinal systolic SR. Hypertensive-diabetics exhibited lower global strain than patients with hypertension only and patients with diabetes only, even though their EF showed no apparent difference. Elevated BNP levels, being the highest among group 4, indicate the presence of ventricular dysfunction, even before chamber failure occurs.

DOI 10.11648/j.ccr.20200403.19
Published in Cardiology and Cardiovascular Research (Volume 4, Issue 3, September 2020)
Page(s) 131-145
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Hypertension, Diabetes, Speckle Tracking Echocardiography, Left Ventricular Functions, Strain, Strain Rate

References
[1] Ilias Karabinos, Charalampos Grassos, Panajiota Kostaki, Athanasios Kranidis (2013) Echocardiography in the evaluation of hypertensive patient: An invaluable tool or simply following the routine? Hellenic J. Cariol. 54: 47-57.
[2] Shi Y, Hu FB (2014) The global implications of diabetes and cancer. Lancet 383: 1947–1948.
[3] Dodiyi-Manuel ST, Akpa MR, Odia OJ (2013) Left ventricular dysfunction in normotensive type II diabetic patients in Port Harcourt, Nigeria. Vasc Health Risk Manag. 9: 529–533.
[4] Landsberg L, Molitch M (2004) Diabetes and hypertension: pathogenesis, prevention and treatment. Clin Exp Hypertens. 26: 621–8.
[5] Bernard M. Y. Cheung, Nelson M. S. Wat, Annette W. K. Tso, Sidney Tam, G. Neil Thomas, Gabriel M. Leung, Hung Fat Tse, Jean Woo, Edward D. Janus, Chu Pak Lau, et al (2008). Association between raised blood pressure and dysglycemia in Hong Kong Chinese. Diabetes Care 31: 1889–91.
[6] Bernard M. Y. Cheung and Chao Li (2012) Diabetes and Hypertension: Is There a Common Metabolic Pathway? Curr Atheroscler Rep 14: 160–166.
[7] Kannel WB, Hjortland M, Castelli WP (1974) Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol. 34: 29–34.
[8] Grossman E, Messerli FH (1996) Diabetic and hypertensive heart disease. Ann Intern Med. 125: 304–310.
[9] Gottdiener JS, Arnold AM, Aurigemma GP, Polak JF, Tracy RP, Kitzman DW, Gardin JM, Rutledge JE, Boineau RC (2000) Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol. 35: 1628–1637.
[10] Dominick M. Carella (2015) Brain Natriuretic Peptide: It’s Not About the Brain or Just Another Smart Polypeptide—It’s About the Heart. Neonatal network. 34: 6.
[11] Hammerer-Lercher A, Neubauer E, Muller S, Pachinger O, Puschendorf B, Mair J (2001) Head-to-head comparison of N terminal pro-brain natriuretic peptide, brain natriuretic peptide and N-terminal pro-atrial natriuretic peptide in diagnosing left ventricular dysfunction. Clin Chim Acta. 310: 193–197.
[12] Ritchie RH, Rosenkranz AC, Kaye DM (2009) B-type natriuretic peptide: endogenous regulator of myocardial structure, biomarker and therapeutic target. Curr Mol Med. 9 (7): 814-25.
[13] A. Battistoni, S. Rubattu, M. Volpe (2012) Circulating biomarkers with preventive, diagnostic and prognostic implications in cardiovascular diseases. Int. J. Cardiol. 157: 160–168.
[14] Kazuhiro Yamamoto, John C. BurnettJr, Michihisa Jougasaki, Rick A. Nishimura, Kent R. Bailey, Yoshihiko Saito, Kazuwa Nakao, and Margaret M. Redfield (1996) Superiority of Brain Natriuretic Peptide as a Hormonal Marker of Ventricular Systolic and Diastolic Dysfunction and Ventricular Hypertrophy. Hypertension 28: 988–994.
[15] de Lemos JA, Morrow DA, Bentley JH (2001) The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes. N Engl J Med. 345: 1014–1021.
[16] P. Gæde, P. Hildebrandt, G. Hess, H.-H. Parving, O. Pedersen (2005) Plasma N-terminal pro-brain natriuretic peptide as a major risk marker for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. Diabetologia 48: 156–163.
[17] Kim DH, Kim HK, Kim MK, Chang SA, Kim YJ, Kim MA, Sohn DW, Oh BH, Park YB (2009) Velocity vector imaging in the measurement of left ventricular twist mechanics: head-to-head one way comparison between speckle tracking echocardiography and velocity vector imaging. J Am Soc Echocardiogr. 22: 1344-52.
[18] Liu YW, Tsai WC, Su CT, Lin CC, Chen JH (2009) Evidence of left ventricular systolic dysfunction detected by automated function imaging in patients with heart failure and preserved left ventricular ejection fraction. J Card Fail. 15: 782–789.
[19] Sanderson JE (2007) Heart failure with a normal ejection fraction. Heart 93: 155–158.
[20] Sharon Ann Hunt, William T. Abraham, Marshall H. Chin, Arthur M. Feldman, Gary S. Francis, Theodore G. Ganiats, Mariell Jessup, Marvin A. Konstam, Donna M. Mancini, Keith Michl, et al (2009) 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults. J Am Coll Cardio. 14: e1–e90.
[21] Mizuguchi Y, Oishi Y, Miyoshi H, Iuchi A, Nagase N, Oki T (2010) Concentric left ventricular hypertrophy brings deterioration of systolic longitudinal, circumferential, and radial myocardial deformation in hypertensive patients with preserved left ventricular pump function. J Cardiol. 55: 23–33.
[22] Nakai H, Takeuchi M, Nishikage T, Lang RM, Otsuji Y (2009) Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration. Eur J Echocardiogr. 10: 926–932.
[23] Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 18: 1440–63.
[24] Richard FM, Richard H and Robert JM (1996) A study guide to epidemiology and biostatistics. 4th Ed. Gaithersburg, Md.: Aspen Publishers, 1996.
[25] Wang Q, Gao Y, Tan K, Xia H, and Li B (2015) Assessment of left ventricular function by three-dimension speckle-tracking echocardiography in well-treated type 2 diabetes patients with or without hypertension. J Clin Ultrasound 43: 502–511.
[26] Bakhoum S W G, Habeeb H A, Elebrashy I N, and Rizk M N (2016) Assessment of left ventricular function in young type 1 diabetes mellitus patients by two-dimensional speckle tracking echocardiography: Relation to duration and control of diabetes. The Egyptian Heart Journal 68 (4): 217-225.
[27] Stevanovic A and Dekleva M (2018) The importance of subclinical left ventricular dysfunction and blood pressure pattern in asymptomatic type 2 diabetic patients: the diagnostic and prognostic significance of tissue Doppler parameters, left ventricular global longitudinal strain, and nighttime blood pressure during sleep. Journal of Diabetes and its Complications 32: 41-47.
[28] Soufi-Taleb N, Tani A M (2016) Impact of diabetes and hypertension on the longitudinal systolic function of the left ventricle. Archives of Cardiovascular Diseases Supplements 8 (1): 81-82 DOI : 10.1016/S1878-6480(16)30232-4.
[29] Zhang X, Wei X, Liang Y, Liu M, Li C, and Tang H (2013) Differential changes of left ventricular myocardial deformation in diabetic patients with controlled and uncontrolled blood glucose: a three-dimensional speckle-tracking echocardiography-based study. J Am Soc Echocardiogr. 26 (5): 499-506. DOI: 10.1016/j.echo.2013.02.016.
[30] Ikonomidis I, Tzortzis S, Triantafyllidi H, Parissis J, Papadopoulos C, Venetsanou K, Trivilou P, Paraskevaidis I, and Lekakis J (2015) Association of impaired left ventricular twisting-untwisting with vascular dysfunction, neurohumoral activation and impaired exercise capacity in hypertensive heart disease. Eur J Heart Fail. 17 (12): 1240-51. doi: 10.1002/ejhf.403. Epub 2015 Oct 7.
[31] Kolesnyk M. Yu (2014) Speckle tracking echocardiography in hypertensive males with glucose metabolism disorders. Zaporozhye Medical Journal 6 (87): 4-10.
[32] Ernande L, Bergerot C, Girerd N, Thibault H, Davidsen ES, Gautier Pignon-Blanc P, Amaz C, Croisille P, De Buyzere ML, Rietzschel ER, Gillebert TC, Moulin P, Altman M, Derumeaux G (2014) Longitudinal myocardial strain alteration is associated with left ventricular remodeling in asymptomatic patients with type 2 diabetes mellitus. J Am Soc Echocardiogr. 27 (5): 479-88. DOI: 10.1016/j.echo.2014.01.001.
[33] Yau-Huei Lai, Chi-In Lo, Yih-Jer Wu, Chung-Lieh Hung, and Hung-I Yeh (2013). Cardiac Remodeling, Adaptations and Associated Myocardial Mechanics in Hypertensive Heart Diseases. Acta Cardiol Sin 29 (1): 64–70.
[34] Imbalzano E, Zito C, Carerj S, Oreto G, Mandraffino G, Cusma-Piccione M, Di Bella G, Saitta C, and Saitta A (2011) Left Ventricular Function in Hypertension: New Insight by Speckle Tracking Echocardiography. Echocardiography 28 (6): 649-657 DOI: 10.1111/j.1540-8175.2011.01410.x.
[35] Li T, Chen S, Guo X, Yang J, Sun Y (2017) Impact of hypertension with or without diabetes on left ventricular remodeling in rural Chinese population: a cross-sectional study. BMC Cardiovasc Disord. 17 (1): 206. doi: 10.1186/s12872-017-0642-y.
[36] Ernande L, Bergerot C, Rietzschel ER, De Buyzere ML, Thibault H, Pignonblanc PG, Croisille P, Ovize M, Groisne L, Moulin P, Gillebert TC, and Derumeaux G (2011) Diastolic dysfunction in patients with type 2 diabetes mellitus: is it really the first marker of diabetic cardiomyopathy? J Am Soc Echocardiogr. 24 (11): 1268-1275. doi: 10.1016/j.echo.2011.07.017.
[37] Lumens J, Delhaas T, Arts T, Cowan BR, Young AA (2006) Impaired subendocardial contractile myofiber function in asymptomatic aged humans, as detected using MRI. Am J Physiol Heart Circ Physiol 291 (4): H1573-9.
[38] Nikitin NP, Witte KK, Thackray SD, de Sileft ventriculara R, Clark AL, Cleland JG (2003) Longitudinal ventricular function: normal values of atrioventricular annular and myocardial velocities measured with quantitative two-dimensional color Doppler tissue imaging. J Am Soc Echocardiogr 16 (9): 906-21.
[39] López B, Querejeta R, González A, Sánchez E, Larman M, Díez J (2004) Effects of loop diuretics on myocardial fibrosis and collagen type I turnover in chronic heart failure. J Am Coll Cardiol. 43: 2028–35.
[40] Hamed W A I, Kamal A M, Noamany M F, Soliman M A, and AbdelRa’ouf M M (2014) Evaluation of left ventricular performance in hypertensive patients by speckle tracking echocardiography: Correlation with brain natriuretic peptide. The Egyptian Heart Journal 66: 299-308.
[41] Bonito P, Moio N, Cavuto L, Covino G, Murena E, Scilla C, Turco S, Capaldo B, Sibilio G. (2005) Early detection of diabetic cardiomyopathy: usefulness of tissue Doppler imaging. Diabet Med 22: 1720.
[42] Von Bibra H, Thrainsdottir IS, Hansen A, Dounis V, Malmberg K, Rydén L. (2005) Tissue Doppler imaging for the detection and quantitation of myocardial dysfunction in patients with type 2 diabetes mellitus. Diab Vasc Dis Res 2: 24.
[43] J. D'hooge, A. Heimdal, F. Jamal, T. Kukulski, B. Bijnens, F. Rademakers, L. Hatle, P. Suetens, G. R. Sutherland (2000) Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur J Echocardiogr 1: 154.
[44] Helle-Valle, Crosby J, Edvardsen T, Lyseggen E, Amundsen BH, Smith HJ, Rosen BD, Lima JA, Torp H, Ihlen H, Smiseth OA. (2005) New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography. Circulation 112: 3149.
[45] Dandel M, Lehmkuhl H, Knosalla C, Suramelashvili N, Hetzer R (2009) Strain and strain rate imaging by echocardiography – basic concepts and clinical applicability. Curr Cardiol Rev. 5: 133-48.
[46] Marwick TH (2006) Measurement of strain and strain rate by echocardiography ready for prime time? J Am Coll Cardiol. 47: 1313-27.
[47] Mondillo S, Galderisi M, Mele D, Cameli M, Lomoriello VS, Zacà Z (2011) Speckle-tracking echocardiography: a new technique for assessing myocardial function. J Ultrasound Med. 30: 71-83.
[48] Fang ZY, Yuda S, Anderson V, Short L, Case C, Marwick TH (2003) Echocardiographic detection of early diabetic myocardial disease. J Am Coll Cardiol. 41: 611-7.
[49] Geyer H, Caracciolo G, Abe H, Wilansky S, Carerj S, Gentile F (2010) Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr. 23: 351-69.
[50] Sadlecki P, Grabiec M, and Walentowicz-Sadlecka M (2016) Prenatal clinical assessment of nt-probnp as a diagnostic tool for preeclampsia, gestational hypertension and gestational diabetes mellitus. PLoS One 11 (9): e0162957. doi: 10.1371/journal.pone.0162957.
[51] Wang TJ, Larson MG, Keyes MJ, Levy D, Benjamin EJ, and Vasan RS (2007) Association of plasma natriuretic peptide levels with metabolic risk factors in ambulatory individuals. Circulation 115 (11): 1345-53.
[52] Abd-El Raof M. M (2014) Evaluation of left ventricular performance in hypertensive patients by speckle tracking echocardiography: correlations with brain natriuretic peptide level. M. Sc. Dissertation, Faculty of Medicine, Menoufia University.
[53] Mishra RK, Li Y, Ricardo AC, Yang W, Keane M, Cuevas M, Christenson R, DeFilippi C, Chen J, He J, Kallem RR, Raj DS, Schelling JR, Wright J, Go AS, Shlipak MG (2013) Association of N-Terminal pro-B-type natriuretic peptide with left ventricular structure and function in chronic kidney disease (from the Chronic Renal Insufficiency Cohort [CRIC]). Am J Cardiol 111: 432–438.
[54] Sonoda H, Ohte N, Goto T, Wakami K, Fukuta H, Kikuchi S, Tani T, Kimura G (2012) Plasma N-terminal pro-brain natriuretic peptide levels identifying left ventricular diastolic dysfunction in patients with preserved ejection fraction. Circ J 76: 2599–2605.
[55] McDonagh T, Robb S, Murdoch D, Morton J, Ford I, Morrison C, Tunstall-Pedoe H, McMurray JJV, Dargie HJ (1998) Biochemical detection of left-ventricular systolic dysfunction. Lancet 351: 9–13.
[56] Troughton RW, Richards AM (2009) B-type natriuretic peptides and echocardiographic measures of cardiac structure and function. JACC: Cardiovascular Imaging 2: 216–225.
Author Information
  • Cardiology Department, Menou?a University, Menoufia, Egypt

  • Biochemistry Department, Menou?a University, Menoufia, Egypt

  • Cardiology Department, Menou?a University, Menoufia, Egypt

  • Cardiology Department of Students’ Hospital, Menou?a University, Menoufia, Egypt

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    Mohammed Fahmy El-Noamany, Ashraf Abd ElRaouf Dawood, Waleed Abdou Ibrahim Hamed, Nowrus Emad Amer. (2020). Assessment of Left Ventricular Functions in Hypertensive Diabetic Patients by Speckle Tracking Imaging: Correlation with Brain Natriuretic Peptide Levels. Cardiology and Cardiovascular Research, 4(3), 131-145. https://doi.org/10.11648/j.ccr.20200403.19

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    Mohammed Fahmy El-Noamany; Ashraf Abd ElRaouf Dawood; Waleed Abdou Ibrahim Hamed; Nowrus Emad Amer. Assessment of Left Ventricular Functions in Hypertensive Diabetic Patients by Speckle Tracking Imaging: Correlation with Brain Natriuretic Peptide Levels. Cardiol. Cardiovasc. Res. 2020, 4(3), 131-145. doi: 10.11648/j.ccr.20200403.19

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    AMA Style

    Mohammed Fahmy El-Noamany, Ashraf Abd ElRaouf Dawood, Waleed Abdou Ibrahim Hamed, Nowrus Emad Amer. Assessment of Left Ventricular Functions in Hypertensive Diabetic Patients by Speckle Tracking Imaging: Correlation with Brain Natriuretic Peptide Levels. Cardiol Cardiovasc Res. 2020;4(3):131-145. doi: 10.11648/j.ccr.20200403.19

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  • @article{10.11648/j.ccr.20200403.19,
      author = {Mohammed Fahmy El-Noamany and Ashraf Abd ElRaouf Dawood and Waleed Abdou Ibrahim Hamed and Nowrus Emad Amer},
      title = {Assessment of Left Ventricular Functions in Hypertensive Diabetic Patients by Speckle Tracking Imaging: Correlation with Brain Natriuretic Peptide Levels},
      journal = {Cardiology and Cardiovascular Research},
      volume = {4},
      number = {3},
      pages = {131-145},
      doi = {10.11648/j.ccr.20200403.19},
      url = {https://doi.org/10.11648/j.ccr.20200403.19},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ccr.20200403.19},
      abstract = {Background: Hypertension and diabetes are major contributors to structural changes including myocardial fibrosis and progressive alteration of LV systolic and diastolic functions. Two-dimensional speckle tracking echocardiography is a reliable imaging modality that overcomes the limitations of Tissue Doppler imaging and allows a more accurate assessment of myocardial deformation at the global and regional levels. Objectives: The investigation aims to assess Left Ventricular functions in patients with hypertension and/or diabetes who have apparently preserved LV systolic function; using speckle tracking echocardiography, and correlate the findings with plasma Brain Natriuretic Peptide levels. Methods: Twenty healthy subjects were enrolled as a control group. Sixty patients with hypertension and/or diabetes were recruited and assembled as three equal groups, hypertensives, diabetics, and hypertensive-diabetics. 2D-STE was performed to assess LV longitudinal strain and strain rate. Plasma BNP levels were measured for all subjects. Results: Global systolic longitudinal strain was significantly reduced in patients compared to controls (P=0.001). It was more reduced in group 4. Global systolic SR was reduced in patients compared to controls, being more significantly reduced in groups 2 and 4 (P=0.001). Global early diastolic SR was reduced in patients compared to controls (P=0.001). Meanwhile, Global late diastolic SR values were higher among patients, especially groups 2 and 4 (P=0.001). BNP levels were significantly higher in group 4 compared to group 1 (P=0.000), group 2 (P=0.000), and group 3 (P=0.000). BNP levels and global systolic strain in group 4 were significantly correlated. Conclusion: LV systolic dysfunction was found among all patients groups, confirmed by the significant reduction in LV global longitudinal systolic SR. Hypertensive-diabetics exhibited lower global strain than patients with hypertension only and patients with diabetes only, even though their EF showed no apparent difference. Elevated BNP levels, being the highest among group 4, indicate the presence of ventricular dysfunction, even before chamber failure occurs.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Assessment of Left Ventricular Functions in Hypertensive Diabetic Patients by Speckle Tracking Imaging: Correlation with Brain Natriuretic Peptide Levels
    AU  - Mohammed Fahmy El-Noamany
    AU  - Ashraf Abd ElRaouf Dawood
    AU  - Waleed Abdou Ibrahim Hamed
    AU  - Nowrus Emad Amer
    Y1  - 2020/08/18
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ccr.20200403.19
    DO  - 10.11648/j.ccr.20200403.19
    T2  - Cardiology and Cardiovascular Research
    JF  - Cardiology and Cardiovascular Research
    JO  - Cardiology and Cardiovascular Research
    SP  - 131
    EP  - 145
    PB  - Science Publishing Group
    SN  - 2578-8914
    UR  - https://doi.org/10.11648/j.ccr.20200403.19
    AB  - Background: Hypertension and diabetes are major contributors to structural changes including myocardial fibrosis and progressive alteration of LV systolic and diastolic functions. Two-dimensional speckle tracking echocardiography is a reliable imaging modality that overcomes the limitations of Tissue Doppler imaging and allows a more accurate assessment of myocardial deformation at the global and regional levels. Objectives: The investigation aims to assess Left Ventricular functions in patients with hypertension and/or diabetes who have apparently preserved LV systolic function; using speckle tracking echocardiography, and correlate the findings with plasma Brain Natriuretic Peptide levels. Methods: Twenty healthy subjects were enrolled as a control group. Sixty patients with hypertension and/or diabetes were recruited and assembled as three equal groups, hypertensives, diabetics, and hypertensive-diabetics. 2D-STE was performed to assess LV longitudinal strain and strain rate. Plasma BNP levels were measured for all subjects. Results: Global systolic longitudinal strain was significantly reduced in patients compared to controls (P=0.001). It was more reduced in group 4. Global systolic SR was reduced in patients compared to controls, being more significantly reduced in groups 2 and 4 (P=0.001). Global early diastolic SR was reduced in patients compared to controls (P=0.001). Meanwhile, Global late diastolic SR values were higher among patients, especially groups 2 and 4 (P=0.001). BNP levels were significantly higher in group 4 compared to group 1 (P=0.000), group 2 (P=0.000), and group 3 (P=0.000). BNP levels and global systolic strain in group 4 were significantly correlated. Conclusion: LV systolic dysfunction was found among all patients groups, confirmed by the significant reduction in LV global longitudinal systolic SR. Hypertensive-diabetics exhibited lower global strain than patients with hypertension only and patients with diabetes only, even though their EF showed no apparent difference. Elevated BNP levels, being the highest among group 4, indicate the presence of ventricular dysfunction, even before chamber failure occurs.
    VL  - 4
    IS  - 3
    ER  - 

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