The predictive role of strain parameters in predicting all-cause mortality in diabetic hypertensive patients with normal left ventricular systolic function in long-term follow-up

Abstract

Objective: To demonstrate the relationship of all-cause mortality in the long term and speckle-tracking echocardiography parameters in a cohort of diabetic hypertensive cases that had preserved left ventricle ejection fraction (LV-EF). Methods: The study included 141 diabetic hypertensive cases with preserved LV-EF were retrospectively analyzed. After applying exclusion criteria, 121 patients were included. Two groups were formed according to out-of-hospital mortality status. Laboratory and echocardiography data were analyzed. Results: The mean age of the 121 patients was 58.4±8.04 years, and the median follow-up duration was 10.08 years. Echocardiographic left atrial strain parameters, namely left atrium reservoir phase strain (35.7±8.7 vs 29.8±7.3, p-value: 0.047), left atrium conduit phase strain (LAScd%) (17.6±5.8 vs 13.3±4.1, p-value: 0.028), and left atrium reservoir phase peak strain (1.5±0.4 vs 1.22±0.3, p-value: 0.037), were worse in the mortality group. In right ventricular strain evaluation, four-chamber right ventricular strain (RV4CSL%) (26.1±5.4 vs. 20.8±6.2, p-value: 0.005) was also worse in the mortality group. Multivariate analysis revealed that the mean daytime systolic blood pressure (odds ratio [OR]: 1.769, p-value: 0.028), LAScd% (OR: 0.820, p-value: 0.015), RV4CSL% (OR: 0.078, p-value: 0.043) independently predicted mortality. Kaplan-Meier analysis showed that LAScd%≤15.3 and RV4CSL%≤24.8 were predictive of mortality (p-values: 0.023 and 0.016, respectively). Conclusion: Strain parameters, assessed via echocardiography, can be useful diagnostic and follow-up tools for determining prognosis and guiding early risk factor management in diabetic hypertensive patients, especially in comparison to traditional volumetric parameters.