Longitudinal Left Ventricular Function in Normotensive Prediabetics: A Tissue Doppler and Strain/Strain Rate Echocardiography Study K€ oksal Ceyhan, MD, Hasan Kadi, MD, Fatih Koc ¸, MD, Atac ¸C ¸ elik, MD, Ahmet € Ozt€ urk, MD, and Orhan € Onalan, MD, Tokat, Turkey Background: Although diabetes mellitus is well known to result in systolic and diastolic left ventricular (LV) dysfunction at the subclinical level, even when it is not accompanied by hypertension and coronary artery disease, this situation has not been sufficiently investigated in prediabetes, which is the precursor of diabetes. The aims of the present study were to investigate LV systolic and diastolic function in normotensive and low-risk prediabetic and diabetic subjects for coronary disease using sensitive tissue Doppler echocardio- graphic parameters, to investigate early possible negative effects of glucose metabolism impairment on LV longitudinal function. Methods: Two hundred subjects (92 with prediabetes, 48 with type 2 diabetes, and 60 age-matched healthy volunteers) were studied by conventional, tissue Doppler, and strain and strain rate echocardiography. All study subjects were normotensive, and coronary artery disease was excluded. Forty-eight patients had isolated fasting glucose impairment, and 44 patients had combined fasting glucose and glucose tolerance impairment. Longitudinal peak systolic strain and the peak systolic and diastolic strain rates of six walls in the apical four-chamber, long-axis, and two-chamber views were evaluated. Results: Clinical and standard echocardiographic characteristics were comparable among all groups. Mean systolic (P = .01) and diastolic (P = .02) tissue velocities, mean strain (P = .004), and mean systolic (P = .002) and diastolic (P = .001) strain rates were significantly lower in the diabetic groups than in control subjects. There were no difference between patients with isolated fasting glucose impairment and controls for tissue Doppler parameters, but mean early diastolic tissue velocity and mean strain and strain rates were statistically lower in patients with combined fasting glucose and glucose tolerance impairment compared with controls (P < .05). Conclusions: LV longitudinal systolic and diastolic function was impaired in both normotensive diabetic and prediabetic patients. (J Am Soc Echocardiogr 2012;25:349-56.) Keywords: Prediabetes, Diastolic dysfunction, Strain rate Diabetes mellitus (DM) is associated with significantly higher heart failure risk, and its prevalence is growing rapidly. Increased ratios of heart failure in diabetic patients persist despite corrections for age, hypertension, obesity, hypercholesterolemia, and coronary artery disease (CAD). It is believed that diastolic dysfunction is an early complication in type 2 DM, and it has been suggested to be the first stage in the development of diabetic cardiomyopathy. Diabetic cardiomyopathy is characterized by defects in both diastolic and systolic function, even in the absence of CAD, hypertension, and left ventricular (LV) hypertrophy. Thus, it is defined as LV dysfunction that occurs independently of CAD and hypertension. 1 Diabetic cardiomyopathy is progressive and involves a progression from the normal heart to preclinical LV diastolic and systolic dysfunction (diagnosed only using advanced imaging techniques), followed by clear echocardiographic evidence of LV dysfunction (still clinically silent) and eventual symptomatic heart failure. Several authors have shown disturbances in subtle indices of systolic and diastolic function, including tissue Doppler, strain, and strain rate, in patients with type 2 DM. 2-4 Prediabetes is a metabolic intermediate state between normal glu- cose tolerance and overt type 2 DM. Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are prediabetic states. According to the American Diabetes Association, patients with iso- lated IFG (i-IFG) have fasting plasma glucose (FPG) levels between $100 and <126 mg/dL and 2-hour plasma glucose levels (measured by an oral glucose tolerance test [OGTT]) <140 mg/dL. Individuals with IGT have FPG concentrations <100 mg/dL and 2-hour plasma glucose concentrations, measured by 75-g OGTT, ranging between $140 and <200 mg/dL. IFG and IGT often coexist. Prediabetes is considered a substantial risk factor for diabetes and is associated with microvascular complications and cardiovascular disease in From the Department of Cardiology, Gaziosmanpasa University Faculty of Medicine, Tokat, Turkey. Reprint requests: K€ oksal Ceyhan, MD, Department of Cardiology, Gaziosmanpasa University Faculty of Medicine, Tokat, Turkey (E-mail: kceyhan09@yahoo.com). 0894-7317/$36.00 Copyright 2012 by the American Society of Echocardiography. doi:10.1016/j.echo.2011.11.018 349