Xiaoxu Yang,1,* Yinjia Zhang,2,* Yao Liu,1 Qing Lv,1 Zhibin Ye,1 Cuiping Jiang,3 Xiaoli Zhang1 

1Department of Nephrology, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China; 2Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, 20040, People’s Republic of China; 3Department of Endocrinology, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xiaoli Zhang, Department of Nephrology, Huadong Hospital, Fudan University, Yan’an Road No. 221, Shanghai, 200040, People’s Republic of China, Email xiaolizhang@fudan.edu.cn Cuiping Jiang, Email litthat@126.com

Objective: This study evaluates cardiac function in older adults with T2DM and preserved LVEF using two-dimensional speckle-tracking echocardiography to explore the risk factors associated with subclinical left ventricular systolic dysfunction (GLS < 18%) in this population.
Methods: All patients (n = 87, aged 60 years and above) and controls (n = 20) underwent clinical assessment and echocardiography, including GLS assessment.
Results: Univariate analysis identified gender (OR 3.368, p=0.008), proteinuria (OR 5.918, p=0.003), eGFR (OR 0.971, p=0.003), HDL (OR 0.201, p=0.013), triglycerides (OR 3.379, p=0.005), and HOMA-IR (OR 1.173, p=0.049) as potential risk factors for subclinical LV systolic insufficiency in older T2DM patients with preserved LVEF. Following adjustment for age and clinical covariates, multivariate logistic regression confirmed proteinuria (OR 4.063, p=0.030), eGFR (OR 0.974, p=0.049), hypertriglyceridemia (OR 3.069, p=0.050), and HOMA-IR (OR 1.249, p=0.026) as independent predictors.
Conclusion: Despite normal global LVEF, proteinuria, hypertriglyceridemia, reduced eGFR, and insulin resistance are closely associated with the development of subclinical left ventricular systolic insufficiency in asymptomatic older adults with T2DM.
Trial Registration: This study adheres to the principles outlined in the Declaration of Helsinki and received approval from the Ethics Review Committee of Huadong Hospital, affiliated with Fudan University (Approval No. 2022K150). Written informed consent was obtained from all participants. The registration number of this study at the Chinese Clinical Trial Center is ChiCTR2200062070.

Keywords: type 2 diabetes, subclinical left ventricular systolic insufficiency, diabetic kidney disease, older adults