{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T22:07:37Z","timestamp":1772921257753,"version":"3.50.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,23]],"date-time":"2021-10-23T00:00:00Z","timestamp":1634947200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,23]],"date-time":"2021-10-23T00:00:00Z","timestamp":1634947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Diabetol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Left ventricular (LV) involvement in diabetic cardiomyopathy has been reported; however, only limited data exist on right ventricular (RV) involvement. Therefore, our purpose was to investigate RV systolic dysfunction and its association with LV longitudinal myocardial dysfunction in patients with type 2 diabetes mellitus (T2DM) and preserved LV ejection fraction (LVEF).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We studied 177 T2DM patients with preserved LVEF and 79 age-, sex-, and LVEF-matched healthy volunteers. LV longitudinal myocardial function was assessed as global longitudinal strain (GLS), and RV systolic function was assessed as RV free-wall strain, and predefined cutoff values for subclinical dysfunction were set at GLS &lt;\u200918% and RV free-wall strain &lt;\u200920%, respectively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>RV free-wall strain in T2DM patients was significantly lower than that in normal controls (19.3%\u2009\u00b1\u20094.8% vs. 24.4%\u2009\u00b1\u20095.1%; P\u2009&lt;\u20090.0001). RV free-wall strain in T2DM patients and LV longitudinal dysfunction was similar compared to that in T2DM patients without (19.0\u2009\u00b1\u20094.5% vs. 19.6\u2009\u00b1\u20095.0%, P\u2009=\u20090.40). Furthermore, multivariate logistic regression analyses showed that GLS was independently associated with RV systolic dysfunction as well as mitral inflow E and mitral e\u2032 annular velocities ratio (odds ratio, 1.16; 95% confidence interval: 1.03\u20131.31; P\u2009&lt;\u20090.05). Sequential logistic models evaluating the association of RV systolic dysfunction in T2DM patients showed an improvement in clinical variables (\u03c7<jats:sup>2<\/jats:sup>\u2009=\u20096.2) with the addition of conventional echocardiographic parameters (\u03c7<jats:sup>2<\/jats:sup>\u2009=\u200913.4, P\u2009&lt;\u20090.001) and a further improvement with the addition of GLS (\u03c7<jats:sup>2<\/jats:sup>\u2009=\u200920.8, P\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>RV subclinical systolic dysfunction was observed in T2DM patients with preserved LVEF and was associated with LV longitudinal myocardial dysfunction. Our findings may provide additional findings for the management of T2DM patients.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12933-021-01404-5","type":"journal-article","created":{"date-parts":[[2021,10,23]],"date-time":"2021-10-23T09:02:48Z","timestamp":1634979768000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Association of left ventricular longitudinal myocardial function with subclinical right ventricular dysfunction in type 2 diabetes mellitus"],"prefix":"10.1186","volume":"20","author":[{"given":"Saki","family":"Todo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidekazu","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Yamauchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shun","family":"Yokota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhide","family":"Mochizuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Shiraki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kentaro","family":"Yamashita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayu","family":"Shono","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makiko","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiko","family":"Sumimoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yushi","family":"Hirota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wataru","family":"Ogawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken-ichi","family":"Hirata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,10,23]]},"reference":[{"key":"1404_CR1","doi-asserted-by":"publisher","first-page":"2035","DOI":"10.1001\/jama.1979.03290450033020","volume":"241","author":"WB Kannel","year":"1979","unstructured":"Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA. 1979;241:2035\u20138.","journal-title":"JAMA"},{"key":"1404_CR2","doi-asserted-by":"publisher","first-page":"905","DOI":"10.2337\/dc14-1877","volume":"38","author":"G Vazquez-Benitez","year":"2015","unstructured":"Vazquez-Benitez G, Desai JR, Xu S, Goodrich GK, Schroeder EB, Nichols GA, Segal J, Butler MG, Karter AJ, Steiner JF, et al. Preventable major cardiovascular events associated with uncontrolled glucose, blood pressure, and lipids and active smoking in adults with diabetes with and without cardiovascular disease: a contemporary analysis. Diabetes Care. 2015;38:905\u201312.","journal-title":"Diabetes Care"},{"key":"1404_CR3","doi-asserted-by":"publisher","first-page":"926","DOI":"10.1093\/ejechocard\/jep097","volume":"10","author":"H Nakai","year":"2009","unstructured":"Nakai H, Takeuchi M, Nishikage T, Lang RM, Otsuji Y. Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration. Eur J Echocardiogr. 2009;10:926\u201332.","journal-title":"Eur J Echocardiogr"},{"key":"1404_CR4","doi-asserted-by":"publisher","first-page":"1398","DOI":"10.1016\/j.amjcard.2009.06.063","volume":"104","author":"AC Ng","year":"2009","unstructured":"Ng AC, Delgado V, Bertini M, van der Meer RW, Rijzewijk LJ, Shanks M, Nucifora G, Smit JW, Diamant M, Romijn JA, et al. Findings from left ventricular strain and strain rate imaging in asymptomatic patients with type 2 diabetes mellitus. Am J Cardiol. 2009;104:1398\u2013401.","journal-title":"Am J Cardiol"},{"key":"1404_CR5","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1016\/j.echo.2014.01.001","volume":"27","author":"L Ernande","year":"2014","unstructured":"Ernande L, Bergerot C, Girerd N, Thibault H, Davidsen ES, Gautier Pignon-Blanc P, Amaz C, Croisille P, De Buyzere ML, Rietzschel ER, et al. Longitudinal myocardial strain alteration is associated with left ventricular remodeling in asymptomatic patients with type 2 diabetes mellitus. J Am Soc Echocardiogr. 2014;27:479\u201388.","journal-title":"J Am Soc Echocardiogr"},{"key":"1404_CR6","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s12933-015-0213-4","volume":"14","author":"Y Mochizuki","year":"2015","unstructured":"Mochizuki Y, Tanaka H, Matsumoto K, Sano H, Toki H, Shimoura H, Ooka J, Sawa T, Motoji Y, Ryo K, et al. Association of peripheral nerve conduction in diabetic neuropathy with subclinical left ventricular systolic dysfunction. Cardiovasc Diabetol. 2015;14:47.","journal-title":"Cardiovasc Diabetol"},{"key":"1404_CR7","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1007\/s10554-017-1198-8","volume":"33","author":"Y Mochizuki","year":"2017","unstructured":"Mochizuki Y, Tanaka H, Matsumoto K, Sano H, Shimoura H, Ooka J, Sawa T, Motoji Y, Ryo-Koriyama K, Hirota Y, et al. Impact of left ventricular longitudinal functional mechanics on the progression of diastolic function in diabetes mellitus. Int J Cardiovasc Imaging. 2017;33:1905\u201314.","journal-title":"Int J Cardiovasc Imaging"},{"key":"1404_CR8","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1136\/heartjnl-2014-307391","volume":"101","author":"DJ Holland","year":"2015","unstructured":"Holland DJ, Marwick TH, Haluska BA, Leano R, Hordern MD, Hare JL, Fang ZY, Prins JB, Stanton T. Subclinical LV dysfunction and 10-year outcomes in type 2 diabetes mellitus. Heart. 2015;101:1061\u20136.","journal-title":"Heart"},{"key":"1404_CR9","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1161\/CIRCULATIONAHA.109.887570","volume":"121","author":"P Meyer","year":"2010","unstructured":"Meyer P, Filippatos GS, Ahmed MI, Iskandrian AE, Bittner V, Perry GJ, White M, Aban IB, Mujib M, Dell\u2019Italia LJ, et al. Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure. Circulation. 2010;121:252\u20138.","journal-title":"Circulation"},{"key":"1404_CR10","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1016\/0735-1097(94)00511-N","volume":"25","author":"TG Di Salvo","year":"1995","unstructured":"Di Salvo TG, Mathier M, Semigran MJ, Dec GW. Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. J Am Coll Cardiol. 1995;25:1143\u201353.","journal-title":"J Am Coll Cardiol"},{"key":"1404_CR11","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1253\/circj.CJ-11-0778","volume":"76","author":"S Guendouz","year":"2012","unstructured":"Guendouz S, Rappeneau S, Nahum J, Dubois-Rande JL, Gueret P, Monin JL, Lim P, Adnot S, Hittinger L, Damy T. Prognostic significance and normal values of 2D strain to assess right ventricular systolic function in chronic heart failure. Circ J. 2012;76:127\u201336.","journal-title":"Circ J"},{"key":"1404_CR12","doi-asserted-by":"publisher","first-page":"1778","DOI":"10.1016\/j.amjcard.2013.07.046","volume":"112","author":"M Cameli","year":"2013","unstructured":"Cameli M, Righini FM, Lisi M, Bennati E, Navarri R, Lunghetti S, Padeletti M, Cameli P, Tsioulpas C, Bernazzali S, et al. Comparison of right versus left ventricular strain analysis as a predictor of outcome in patients with systolic heart failure referred for heart transplantation. Am J Cardiol. 2013;112:1778\u201384.","journal-title":"Am J Cardiol"},{"key":"1404_CR13","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s12933-020-01055-y","volume":"19","author":"PBC Linssen","year":"2020","unstructured":"Linssen PBC, Veugen MGJ, Henry RMA, van der Kallen CJH, Kroon AA, Schram MT, Brunner-La Rocca HP, Stehouwer CDA. Associations of (pre)diabetes with right ventricular and atrial structure and function: the Maastricht study. Cardiovasc Diabetol. 2020;19:88.","journal-title":"Cardiovasc Diabetol"},{"key":"1404_CR14","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1016\/j.amjcard.2017.11.040","volume":"121","author":"TM Gorter","year":"2018","unstructured":"Gorter TM, Streng KW, van Melle JP, Rienstra M, Dickinson MG, Lam CSP, Hummel YM, Voors AA, Hoendermis ES, van Veldhuisen DJ. Diabetes mellitus and right ventricular dysfunction in heart failure with preserved ejection fraction. Am J Cardiol. 2018;121:621\u20137.","journal-title":"Am J Cardiol"},{"key":"1404_CR15","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1038\/hr.2012.137","volume":"36","author":"F Paneni","year":"2013","unstructured":"Paneni F, Gregori M, Tocci G, Palano F, Ciavarella GM, Pignatelli G, Marra A, Sciarretta S, Ferrucci A, Volpe M. Do diabetes, metabolic syndrome or their association equally affect biventricular function? A tissue Doppler study. Hypertens Res. 2013;36:36\u201342.","journal-title":"Hypertens Res"},{"key":"1404_CR16","doi-asserted-by":"publisher","first-page":"2736","DOI":"10.2337\/diacare.27.11.2736","volume":"27","author":"W Kosmala","year":"2004","unstructured":"Kosmala W, Colonna P, Przewlocka-Kosmala M, Mazurek W. Right ventricular dysfunction in asymptomatic diabetic patients. Diabetes Care. 2004;27:2736\u20138.","journal-title":"Diabetes Care"},{"key":"1404_CR17","doi-asserted-by":"publisher","first-page":"457","DOI":"10.2337\/dc12-0474","volume":"36","author":"RL Widya","year":"2013","unstructured":"Widya RL, van der Meer RW, Smit JW, Rijzewijk LJ, Diamant M, Bax JJ, de Roos A, Lamb HJ. Right ventricular involvement in diabetic cardiomyopathy. Diabetes Care. 2013;36:457\u201362.","journal-title":"Diabetes Care"},{"key":"1404_CR18","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1007\/s00592-016-0874-9","volume":"53","author":"M Tadic","year":"2016","unstructured":"Tadic M, Cuspidi C, Vukomanovic V, Ilic S, Celic V, Obert P, Kocijancic V. The influence of type 2 diabetes and arterial hypertension on right ventricular layer-specific mechanics. Acta Diabetol. 2016;53:791\u20137.","journal-title":"Acta Diabetol"},{"key":"1404_CR19","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1002\/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S","volume":"15","author":"KG Alberti","year":"1998","unstructured":"Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539\u201353.","journal-title":"Diabet Med."},{"key":"1404_CR20","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1093\/ehjci\/jev014","volume":"16","author":"RM Lang","year":"2015","unstructured":"Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233\u201370.","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"1404_CR21","doi-asserted-by":"publisher","first-page":"3452","DOI":"10.1093\/eurheartj\/ehu193","volume":"35","author":"V Melenovsky","year":"2014","unstructured":"Melenovsky V, Hwang SJ, Lin G, Redfield MM, Borlaug BA. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014;35:3452\u201362.","journal-title":"Eur Heart J"},{"key":"1404_CR22","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1161\/CIRCULATIONAHA.106.632208","volume":"114","author":"NF Voelkel","year":"2006","unstructured":"Voelkel NF, Quaife RA, Leinwand LA, Barst RJ, McGoon MD, Meldrum DR, Dupuis J, Long CS, Rubin LJ, Smart FW, et al. Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation. 2006;114:1883\u201391.","journal-title":"Circulation"},{"key":"1404_CR23","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1161\/CIRCULATIONAHA.107.653584","volume":"117","author":"F Haddad","year":"2008","unstructured":"Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008;117:1717\u201331.","journal-title":"Circulation"},{"key":"1404_CR24","doi-asserted-by":"publisher","first-page":"3213","DOI":"10.1161\/CIRCULATIONAHA.106.679597","volume":"115","author":"S Boudina","year":"2007","unstructured":"Boudina S, Abel ED. Diabetic cardiomyopathy revisited. Circulation. 2007;115:3213\u201323.","journal-title":"Circulation"},{"key":"1404_CR25","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1093\/eurheartj\/ehn153","volume":"29","author":"MR MacDonald","year":"2008","unstructured":"MacDonald MR, Petrie MC, Varyani F, Ostergren J, Michelson EL, Young JB, Solomon SD, Granger CB, Swedberg K, Yusuf S, et al. Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: an analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J. 2008;29:1377\u201385.","journal-title":"Eur Heart J"},{"key":"1404_CR26","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1111\/j.1463-1326.2006.00609.x","volume":"9","author":"MR Movahed","year":"2007","unstructured":"Movahed MR. Diabetes as a risk factor for cardiac conduction defects: a review. Diabetes Obes Metab. 2007;9:276\u201381.","journal-title":"Diabetes Obes Metab"},{"key":"1404_CR27","doi-asserted-by":"publisher","first-page":"1903","DOI":"10.1016\/j.jacc.2009.06.048","volume":"54","author":"CA Warnes","year":"2009","unstructured":"Warnes CA. Adult congenital heart disease importance of the right ventricle. J Am Coll Cardiol. 2009;54:1903\u201310.","journal-title":"J Am Coll Cardiol"},{"key":"1404_CR28","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.echo.2014.11.017","volume":"28","author":"M Tadic","year":"2015","unstructured":"Tadic M, Celic V, Cuspidi C, Ilic S, Pencic B, Radojkovic J, Ivanovic B, Stanisavljevic D, Kocabay G, Marjanovic T. Right heart mechanics in untreated normotensive patients with prediabetes and type 2 diabetes mellitus: a two- and three-dimensional echocardiographic study. J Am Soc Echocardiogr. 2015;28:317\u201327.","journal-title":"J Am Soc Echocardiogr"},{"key":"1404_CR29","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1038\/nrcardio.2016.25","volume":"13","author":"B Ziaeian","year":"2016","unstructured":"Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016;13:368\u201378.","journal-title":"Nat Rev Cardiol"}],"container-title":["Cardiovascular Diabetology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12933-021-01404-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12933-021-01404-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12933-021-01404-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,23]],"date-time":"2021-10-23T09:03:36Z","timestamp":1634979816000},"score":1,"resource":{"primary":{"URL":"https:\/\/cardiab.biomedcentral.com\/articles\/10.1186\/s12933-021-01404-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,23]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1404"],"URL":"https:\/\/doi.org\/10.1186\/s12933-021-01404-5","relation":{},"ISSN":["1475-2840"],"issn-type":[{"value":"1475-2840","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,23]]},"assertion":[{"value":"17 August 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 October 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the local ethics committee of Kobe University Hospital (No. B210127).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The consent to publish was obtained from all participants in this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"212"}}