Myocardial work in hypertensive patients with and without diabetes: An echocardiographic study

We aimed to investigate myocardial performance using pressure-strain loops in hypertensive patients with and without type 2 diabetes mellitus (DM). This cross-sectional study included 165 subjects (55 controls, 60 hypertensive patients without DM, and 50 hypertensive patients with DM) who underwent complete two-dimensional echocardiographic examination (2DE) including two-dimensional speckle-tracking echocardiography. Pressure-strain curve was used to determine global myocardial work index, constructive work, wasted work, and work efficiency in all study participants. Left ventricular (LV) longitudinal and circumferential strains gradually reduced from controls throughout hypertensive subjects to patients with DM and hypertension. Global myocardial work index gradually increased from controls, throughout hypertensive patients to subjects with hypertension and DM (1887 ± 289 vs 2073 ± 311 vs 2144 ± 345 mm Hg%, P = .001). Constructive work increased in the same direction (2040 ± 319 vs 2197 ± 344 vs 2355 ± 379 mm Hg%, P < .001). Work efficiency and wasted work did not differ between three observed groups. Glycosylated hemoglobin and systolic blood pressure were associated with global myocardial work and constructive work independently of age, body mass index, LV structural and functional parameters in all hypertensive participants. In conclusion, pressure-strain curve showed that myocardial work was significantly affected by hypertension and diabetes. Diabetes demonstrated an additional negative effect on myocardial work in hypertensive patients.