Resting Left Ventricular Global Longitudinal Strain to Identify Silent Myocardial Ischemia in Asymptomatic Patients with Diabetes Mellitus

Abstract Background Screening silent coronary artery disease (CAD) in asymptomatic patients with diabetes mellitus (DM) is challenging and controversial. In this context, it seems crucial to identify early markers of CAD. Methods We aimed to investigate the incremental value of resting left ventricular global longitudinal strain (LV GLS) for the prediction of positive stress (exercise or Dobutamine) TTE in 273 consecutive asymptomatic high-risk patients with diabetes mellitus (DM). Positive stress TTE was defined as stress-induced left ventricular wall motion abnormalities (new or worsening of pre-existing abnormalities). Results Compared to patients with negative stress test, patients with positive stress test (n=28, 10%) had more frequent cardiovascular risk factors, complications of diabetes, vascular disease, moderate and severe calcification of the aortic valve and mitral annulus and worse resting LV GLS (-16.7±2.9 vs. -19.0±1.9%; p 10 years, diabetic retinopathy, left ventricular hypertrophy and impaired LV GLS (OR[95%CI]=1.39 [1.14-1.70] per % increase, OR[95%CI]=5.16[1.96-13.59] for LV GLS worse than -18%) were independently associated with a positive stress TTE. The AUC to predict the test positivity was 0.74 for LV GLS with a cutoff of -18.0% (se=68%, spe=78%). The AUC of the multivariable model to predict test results was improved by the addition of LV GLS (p Conclusion Our study supports that resting LV GLS is associated with the presence of silent ischemia and could be useful to better identify asymptomatic patients with DM who might benefit from CAD screening.