Methods for Ultrasound Screening of Cardiovascular Diseases in Type 2 Diabetic Patients

Open access


Diabetes mellitus is a chronic disorder that affects predominantly the carbohydrate metabolism, but also the biotransformation of proteins and fat. Many intra- and extracellular metabolic mechanisms are impaired which leads to structural changes in the vascular wall and the heart muscle. This eventually causes their functional deterioration and the end result is clinical manifestation of macrovascular incidents or heart failure. People with perturbations of the glucose metabolism (impaired fasting glucose, impaired glucose tolerance and insulin resistance) are also with a higher risk of cardiovascular diseases, even before the diagnosis of diabetes. Nowadays we have a cheap, easy and non-invasive method for early diagnosis of cardiovascular disorders, way before their clinical manifestation, and that is the ultrasound methodology. The echocardiography is a valuable technique for the detection of changes in the myocardial structure and its contractility. The tissue Doppler ultrasound is a more precise method that can detect the slightest aberrations in the heart muscle function, that could not be seen with the conventional echocardiography. Subclinical atherosclerotic changes can be determined with a Doppler scan of the big arteries (carotids, renal arteries), and the subsequent calculation of their resistive index and of the intima-media thickness. There are a lot of studies in this field which show that the structural and functional impairment could be diagnosed in diabetic patients without any complaints and with otherwise healthy hearts. This means that these diagnostic methods should be used in the routine clinical examination of every diabetic individual in order to predict and possibly prevent major cardiovascular events and severe heart failure.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. WH Organization. Diabetes. Fact Sheet N312 2014. Accessed Nov 2014.

  • 2. World Health Organization (WHO) Consultation. Definition and diagnosis of diabetes and intermediate hyperglycaemia. 2006

  • 3. The DECODE Study Group. Is the current definition for diabetes relevant to mortality risk from all causes and cardiovascular and noncardiovascular diseases? Diabetes Care 2003;26:688-696.

  • 4. Norhammar A Tenerz Å Nilsson G et al . Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus. A prospective study. Lancet 2002; 359: 2140-2144.

  • 5. Lang R Biering M Devereux RB et al. Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group Developed in Conjuction with the European Association of Echocardiography a Branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18(12): 1440-1463.

  • 6. Popescu BA Carmen CB Carmen G. Echocardiographic ssessment of diastolic heart failure. European Cardiology 2010 6(3): 13-17.

  • 7. Liu JH Chen Y Yuen M et al. Incremental prognostic value of global longitudinal strain in patients with type 2 diabetes mellitus. Cardiovasc Diabetol. 2016;15:22. doi:

    • Crossref
    • Export Citation
  • 8. Mitrovska S Lazeska B. Contemporary Echocardiographic Techniques in Early Detection of Diabetic Cardiomyopathy. J Cardiol Curr Res 2014; 1(5): 00025.

  • 9. Boyer J Thanigaraj S Schechtman KB Perez JE (2004) Prevalence of ventricular diastolic dysfunction in asymptomatic normotensive patients with diabetes mellitus. Am J Cardiol 93(7): 870-875.

  • 10. Zahiti BF Gorani DR Gashi FB et al. Left Ventricular Diastolic Dysfunction in Asymptomatic Type 2 Diabetic Patients: Detection and Evaluation by Tissue Doppler Imaging. Acta Informatica Medica 2013;21(2):120-123.

  • 11. Hölscher ME Bode C Bugger H. Diabetic Cardiomyopathy: Does the Type of Diabetes Matter? Int J Mol Sci. 2016 Dec 18;17(12) pii: E2136.

  • 12. An D. Rodrigues B. Role of changes in cardiac metabolism in development of diabetic cardiomyopathy. Am J Physiol Heart Circ Physiol. 291 2006:H1489-H1506.

  • 13. Giacco F Brownlee M. Oxidative stress and diabetic complications. Circ Res. 2010;107(9):1058-70.

  • 14. Bergerot C Davidsen ES Amaz C et al. Diastolic function deterioration in type 2 diabetes mellitus: predictive factors over a 3-year follow-up. Eur Heart J Cardiovasc Imaging. 2017 Feb 6. doi:

    • Crossref
    • Export Citation
  • 15. Fontes-Carvalho R Ladeiras-Lopes R Bettencourt P et al. Diastolic dysfunction in the diabetic continuum: association ith insulin resistance metabolic syndrome and type 2 diabetes. Cardiovasc Diabetol. 2015 Jan 13;14:4. doi:

    • Crossref
    • Export Citation
  • 16. Paneni F Gregori M Tocci G et al. Do diabetes metabolic syndrome or their association equally affect biventricular function? A tissue Doppler study. Hypertens Res. 2013 Jan;36(1):36-42.

  • 17. Ofstad AP Urheim S Dalen H et al. Identification of a definite diabetic cardiomyopathy in type 2 diabetes by comprehensive echocardiographic evaluation: A cross-sectional comparison with non-diabetic weight-matched controls. J Diabetes. 2015 Nov;7(6):779-90.

  • 18. De Jong KA Czeczor JK Sithara S et al. Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study. Cardiovasc Diabetol. 2017 Feb 8;16(1):21.

  • 19. Jørgensen PG Jensen MT Mogelvang R et al. Abnormal echocardiography in patients with type 2 diabetes and relation to symptoms and clinical characteristics. Diab Vasc Dis Res. 2016 Sep;13(5):321-30.

  • 20. Rossi A Zoppini G Benfari G et al. Mitral Regurgitation and Increased Risk of All-Cause and Cardiovascular Mortality in Patients with Type 2 Diabetes. Am J Med. 2017 Jan;130(1):70-76.e1.

  • 21. Blomstrand P Engvall M Festin K et al. Left ventricular diastolic function assessed by echocardiography and tissue Doppler imaging is a strong predictor of cardiovascular events superior to global left ventricular longitudinal strain in patients with type 2 diabetes. Eur Heart J Cardiovasc Imaging. 2015;16(9):1000-7.

  • 22. Naqvi TZ Lee MS. Carotid intima-media thickness and plaque in cardiovascular risk assessment. JACC Cardiovasc Imaging. 2014;7(10):1025-38.

  • 23. Niu L Zhang Y Qian M et al. Impact of multiple cardiovascular risk factors on carotid intima-media thickness and elasticity. PLoS One. 2013 2;8(7):e67809.

  • 24. Baldassarre D Hamsten A Veglia F et al. IMPROVE Study Group. Measurements of carotid intima-media thickness and of interadventitia common carotid diameter improve prediction of cardiovascular events: results of the IMPROVE (Carotid Intima Media Thickness [IMT] and IMTProgression as Predictors of Vascular Events in a High Risk European Population) study. J Am Coll Cardiol. 2012 Oct 16;60(16):1489-99.

  • 25. Plasencia Martínez JM Garcia Santos JM Paredes Martinez ML Pastor AM. Carotid intima-media thickness and hemodynamic parameters: reproducibility of manual measurements with Doppler ultrasound. Med Ultrason. 2015;17(2):167-74.

  • 26. Touboul PJ Hennerici MG Meairs S et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006- 2011). An update on behalf of the advisory board of the 3rd 4th and 5th watching the risk symposia at the 13th 15th and 20th European Stroke Conferences Mannheim Germany 2004 Brussels Belgium 2006 and Hamburg Germany 2011. Cerebrovasc Dis. 2012;34(4):290-6.

  • 27. Gállego Pérez-Larraya J Irimia P Martínez-Vila E et al. The influence of obesity on the assessment of carotid intima-media thickness. J Clin Ultrasound. 2012 Oct;40(8):479-85.

  • 28. Badeĭnikova KK Mazaev AP Toguzova ZA et al. [Detection of early markers of atherosclerosis in men with various levels of risk of cardiovascular complications]. Kardiologiia. 2014;54(6):35-9.

  • 29. Silvestrini M Altamura C Cerqua R et al. Ultrasonographic markers of vascular risk in patients with asymptomatic carotid stenosis. J Cereb Blood Flow Metab. 2013;33(4):619-24.

  • 30. Lubas A Kade G Niemczyk S. Renal resistive index as a marker of vascular damage in cardiovascular diseases. Int Urol Nephrol. 2014;46(2):395-402.

  • 31. Kawai T Kamide K Onishi M et al. Usefulness of the resistive index in renal Doppler ultrasonography as an indicator of vascular damage in patients with risks of atherosclerosis. Nephrol Dial Transplant. 2011;26(10):3256-62.

  • 32. Bruno RM Daghini E Landini L et al. Dynamic evaluation ofrenal resistive index in normoalbuminuric patients with newly diagnosed hypertension or type 2 diabetes. Diabetologia. 2011;54:2430-2439.

  • 33. Mancini M Masulli M Liuzzi R et al. Renal duplex sonographic evaluation of type 2 diabetic patients. J Ultrasound Med. 2013;32(6):1033-40.

  • 34. MacIsaac RJ Thomas MC Panagiotopoulos S et al. Association between intrarenal arterial resistance and diastolic dysfunction in type 2 diabetes. Cardiovasc Diabetol. 2008 23;7:15. doi:

    • Crossref
    • Export Citation
  • 35. Kinouchi M Aihara K Fujinaka Y et al. Diabetic conditions differentially affect the endothelial function arterial stiffness and carotid atherosclerosis. J Atheroscler Thromb. 2014;21(5):486-500.

  • 36. Staub D Meyerhans A Bundi B et al. Prediction of cardiovascular morbidity and mortality: comparison of the internal carotid artery resistive index with the common carotid artery intima-media thickness. Stroke. 2006;37(3):800-5.

  • 37. Chung H Jung YH Kim KH et al. Carotid Artery End- Diastolic Velocity and Future Cerebro-Cardiovascular Events in Asymptomatic High Risk Patients. Korean Circ J. 2016;46(1):72-8.

Journal information
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 296 137 4
PDF Downloads 133 72 5