Value of Left Ventricular Layer-specific Strain in Detecting Left Ventricular Dysfunction in Diabetes Patients with Left Ventricular Remodeling and Non-remodeling

Kun Li; Jingqi Wang; Ling Liao; Chunmei Li

doi:doi:10.11648/j.ijacm.20261401.14

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| Peer-Reviewed

Value of Left Ventricular Layer-specific Strain in Detecting Left Ventricular Dysfunction in Diabetes Patients with Left Ventricular Remodeling and Non-remodeling

Kun Li

, Jingqi Wang

, Ling Liao

, Chunmei Li^*

Published in International Journal of Anesthesia and Clinical Medicine (Volume 14, Issue 1)

Received: 1 February 2026 Accepted: 13 February 2026 Published: 26 February 2026

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Abstract

To explore the application of left ventricular (LV) stratified strain in evaluating early systolic dysfunction in diabetes patients with and without LV remodeling by using two-dimensional speckle tracking echocardiography (2DSTE), This study included 35 diabetes patients and 25 healthy individuals. All participants completed echography by GE Vivid E9 ultrasound system. The diabetes patients were subdivided based on relative wall thickness into normal LV geometry group and LV remodeling group. The EchoPAC offline workstation was used to analyze LV myocardial longitudinal layer-specific strain. Our results showed that compared to the control group, the absolute values of longitudinal strain in the endocardial, mid-myocardial, and epicardial layers of the 3-chamber view, the epicardial layer of the 4-chamber view, as well as the average longitudinal strain of the mid-myocardial and epicardial layers across all three views, were significantly decreased in the diabetes group (P < 0.05). Compared to the control group, both the normal LV geometry and LV remodeling subgroups showed significantly reduced absolute values of longitudinal strain in the epicardial layer of the 3-chamber and 4-chamber views, and in the average epicardial strain across all three views (P < 0.05), with the most pronounced changes observed in the LV remodeling group. Furthermore, compared to the control group, the LV remodeling subgroup exhibited significantly reduced absolute values of longitudinal strain in the endocardial and mid-myocardial layers of the 3-chamber view, the endocardial layer of the 4-chamber view, and the average mid-myocardial strain across all three views (P < 0.05). A significant decrease in the absolute value of epicardial longitudinal strain in the 3-chamber view was also found in the LV remodeling group compared to the normal LV geometry group (P < 0.05). The study reveals that in diabetes patients with either normal LV geometry or LV remodeling, impairment of epicardial longitudinal strain in the 3-chamber and 4-chamber views, as well as the average epicardial strain, occurs earlier. In diabetes patients with LV remodeling, longitudinal strain in the endocardial and mid-myocardial layers of the 3-chamber view, the endocardial layer of the 4-chamber view, and the average mid-myocardial strain were the most sensitively impaired parameters. Additionally, the impairment of myocardial longitudinal strain was most pronounced in the apical 3-chamber view.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 14, Issue 1)
DOI	10.11648/j.ijacm.20261401.14
Page(s)	21-30
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Echocardiography, Two-dimensional Speckle Tracking Echocardiography, Diabetes Mellitus, Left Ventricular Layer-specific Strain, Left Ventricular Function

References

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[2]	Bhagyalakshmi, Balakrishnan, Raghu Chandrashekar, et al. Hyperglycaemia to heart failure: molecular pathophysiology, clinical manifestations, and novel therapeutic targets for diabetic cardiomyopathy. [J]. Arch Physiol Biochem, 2025, undefined: 1-14. https://doi.org/10.1080/13813455.2025.2567336
[3]	W B, Kannel, M, et al. Role of diabetes in congestive heart failure: the Framingham study. [J]. Am J Cardiol, 1974, 34: 29-34. https://doi.org/10.1016/0002-9149(74)90089-7
[4]	Mohapradeep, Mohan, Adel, et al. Left Ventricular Hypertrophy in Diabetic Cardiomyopathy: A Target for Intervention. [J]. Front Cardiovasc Med, 2021, 8: 746382. https://doi.org/10.3389/fcvm.2021.746382
[5]	Victor, Mor-Avi, Roberto M, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. [J].J Am Soc Echocardiogr, 2011, 24: 277-313. https://doi.org/10.1016/j.echo.2011.01.015
[6]	Elizabeth, Potter, Thomas H, et al. Assessment of Left Ventricular Function by Echocardiography: The Case for Routinely Adding Global Longitudinal Strain to Ejection Fraction. [J]. JACC Cardiovasc Imaging, 2018, 11: 260-274. https://doi.org/10.1016/j.jcmg.2017.11.017
[7]	Victoria, Delgado, Nina, et al. Implementing Quality Control of LV Longitudinal Strain Measurement. [J]. JACC Cardiovasc Imaging, 2016, 10: 523-525. https://doi.org/10.1016/j.jcmg.2016.09.003
[8]	Darae, Kim, Chi Young, et al. Differences in left ventricular functional adaptation to arterial stiffness and neurohormonal activation in patients with hypertension: a study with two-dimensional layer-specific speckle tracking echocardiography. [J]. Clin Hypertens, 2017, 23: 21. https://doi.org/10.1186/s40885-017-0078-9
[9]	Otto A, Smiseth, et al. Myocardial strain imaging: how useful is it in clinical decision making? [J]. Eur Heart J, 2015, 37: 1196-207. https://doi.org/10.1093/eurheartj/ehv529
[10]	Patrick, Garceau, Shemy, et al. Evaluation of left ventricular relaxation and filling pressures in obstructive hypertrophic cardiomyopathy: comparison between invasive hemodynamics and two-dimensional speckle tracking. [J]. Echocardiography, 2012, 29: 934-42. https://doi.org/10.1111/j.1540-8175.2012.01708.x
[11]	Ieva, Kažukauskienė, Giedrė, et al. Left ventricular global longitudinal strain predicts elevated cardiac pressures and poor clinical outcomes in patients with non-ischemic dilated cardiomyopathy. [J]. Cardiovasc Ultrasound, 2021, 19: 21. https://doi.org/10.1186/s12947-021-00254-1
[12]	Wei-Ting, Chang, Wen-Huang, et al. Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients. [J]. Intensive Care Med, 2015, 41: 1791-9. https://doi.org/10.1007/s00134-015-3970-3
[13]	Despina-Manuela, Toader, Alina, et al. Layer-Specific Strain Analysis in Patients with Dilated Cardiomyopathy. [J]. Biomedicines, 2025, 13: https://doi.org/10.3390/biomedicines13010011
[14]	Helmut, Baumgartner, Judy, et al. Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. [J]. J Am Soc Echocardiogr, 2017, 30: 372-392. https://doi.org/10.1016/j.echo.2017.02.009
[15]	Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025. [J]. Diabetes Care, 2024, 48: S27-S49. https://doi.org/10.2337/dc25-S002
[16]	Xudong, Zhao, Shengwang, et al. Diabetic cardiomyopathy: Clinical phenotype and practice. [J]. Front Endocrinol (Lausanne), 2022, 13: 1032268. https://doi.org/10.3389/fendo.2022.1032268
[17]	Ilaria, Russo, Nikolaos G, et al. Diabetes-associated cardiac fibrosis: Cellular effectors, molecular mechanisms and therapeutic opportunities. [J]. J Mol Cell Cardiol, 2015, 90: 84-93. https://doi.org/10.1016/j.yjmcc.2015.12.011
[18]	Izabela, Tuleta, Nikolaos G, et al. Fibrosis of the diabetic heart: Clinical significance, molecular mechanisms, and therapeutic opportunities. [J]. Adv Drug Deliv Rev, 2021, 176: 113904. https://doi.org/10.1016/j.addr.2021.113904
[19]	Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2024. [J]. Diabetes Care, 2023, 47: S179-S218. https://doi.org/10.2337/dc24-S010
[20]	Christos G, Mihos, Jennifer E, et al. Speckle-Tracking Strain Echocardiography for the Assessment of Left Ventricular Structure and Function: A Scientific Statement From the American Heart Association. [J]. Circulation, 2025, 152: e96-e109. https://doi.org/10.1161/CIR.0000000000001354
[21]	Loek, van Heerebeek, Nazha, et al. Diastolic stiffness of the failing diabetic heart: importance of fibrosis, advanced glycation end products, and myocyte resting tension. [J]. Circulation, 2007, 117: 43-51. https://doi.org/10.1161/CIRCULATIONAHA.107.728550
[22]	João Pedro Thimotheo, Batista, André Oliveira Vilela de, et al. The Role of Renin-Angiotensin System in Diabetic Cardiomyopathy: A Narrative Review. [J]. Life (Basel), 2023, 13. https://doi.org/10.3390/life13071598

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APA Style

Li, K., Wang, J., Liao, L., Li, C. (2026). Value of Left Ventricular Layer-specific Strain in Detecting Left Ventricular Dysfunction in Diabetes Patients with Left Ventricular Remodeling and Non-remodeling. International Journal of Anesthesia and Clinical Medicine, 14(1), 21-30. https://doi.org/10.11648/j.ijacm.20261401.14

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ACS Style

Li, K.; Wang, J.; Liao, L.; Li, C. Value of Left Ventricular Layer-specific Strain in Detecting Left Ventricular Dysfunction in Diabetes Patients with Left Ventricular Remodeling and Non-remodeling. Int. J. Anesth. Clin. Med. 2026, 14(1), 21-30. doi: 10.11648/j.ijacm.20261401.14

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AMA Style

Li K, Wang J, Liao L, Li C. Value of Left Ventricular Layer-specific Strain in Detecting Left Ventricular Dysfunction in Diabetes Patients with Left Ventricular Remodeling and Non-remodeling. Int J Anesth Clin Med. 2026;14(1):21-30. doi: 10.11648/j.ijacm.20261401.14

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@article{10.11648/j.ijacm.20261401.14,
  author = {Kun Li and Jingqi Wang and Ling Liao and Chunmei Li},
  title = {Value of Left Ventricular Layer-specific Strain in Detecting Left Ventricular Dysfunction in Diabetes Patients with Left Ventricular Remodeling and Non-remodeling},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {14},
  number = {1},
  pages = {21-30},
  doi = {10.11648/j.ijacm.20261401.14},
  url = {https://doi.org/10.11648/j.ijacm.20261401.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20261401.14},
  abstract = {To explore the application of left ventricular (LV) stratified strain in evaluating early systolic dysfunction in diabetes patients with and without LV remodeling by using two-dimensional speckle tracking echocardiography (2DSTE), This study included 35 diabetes patients and 25 healthy individuals. All participants completed echography by GE Vivid E9 ultrasound system. The diabetes patients were subdivided based on relative wall thickness into normal LV geometry group and LV remodeling group. The EchoPAC offline workstation was used to analyze LV myocardial longitudinal layer-specific strain. Our results showed that compared to the control group, the absolute values of longitudinal strain in the endocardial, mid-myocardial, and epicardial layers of the 3-chamber view, the epicardial layer of the 4-chamber view, as well as the average longitudinal strain of the mid-myocardial and epicardial layers across all three views, were significantly decreased in the diabetes group (P < 0.05). Compared to the control group, both the normal LV geometry and LV remodeling subgroups showed significantly reduced absolute values of longitudinal strain in the epicardial layer of the 3-chamber and 4-chamber views, and in the average epicardial strain across all three views (P < 0.05), with the most pronounced changes observed in the LV remodeling group. Furthermore, compared to the control group, the LV remodeling subgroup exhibited significantly reduced absolute values of longitudinal strain in the endocardial and mid-myocardial layers of the 3-chamber view, the endocardial layer of the 4-chamber view, and the average mid-myocardial strain across all three views (P < 0.05). A significant decrease in the absolute value of epicardial longitudinal strain in the 3-chamber view was also found in the LV remodeling group compared to the normal LV geometry group (P < 0.05). The study reveals that in diabetes patients with either normal LV geometry or LV remodeling, impairment of epicardial longitudinal strain in the 3-chamber and 4-chamber views, as well as the average epicardial strain, occurs earlier. In diabetes patients with LV remodeling, longitudinal strain in the endocardial and mid-myocardial layers of the 3-chamber view, the endocardial layer of the 4-chamber view, and the average mid-myocardial strain were the most sensitively impaired parameters. Additionally, the impairment of myocardial longitudinal strain was most pronounced in the apical 3-chamber view.},
 year = {2026}
}

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TY  - JOUR
T1  - Value of Left Ventricular Layer-specific Strain in Detecting Left Ventricular Dysfunction in Diabetes Patients with Left Ventricular Remodeling and Non-remodeling
AU  - Kun Li
AU  - Jingqi Wang
AU  - Ling Liao
AU  - Chunmei Li
Y1  - 2026/02/26
PY  - 2026
N1  - https://doi.org/10.11648/j.ijacm.20261401.14
DO  - 10.11648/j.ijacm.20261401.14
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 21
EP  - 30
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20261401.14
AB  - To explore the application of left ventricular (LV) stratified strain in evaluating early systolic dysfunction in diabetes patients with and without LV remodeling by using two-dimensional speckle tracking echocardiography (2DSTE), This study included 35 diabetes patients and 25 healthy individuals. All participants completed echography by GE Vivid E9 ultrasound system. The diabetes patients were subdivided based on relative wall thickness into normal LV geometry group and LV remodeling group. The EchoPAC offline workstation was used to analyze LV myocardial longitudinal layer-specific strain. Our results showed that compared to the control group, the absolute values of longitudinal strain in the endocardial, mid-myocardial, and epicardial layers of the 3-chamber view, the epicardial layer of the 4-chamber view, as well as the average longitudinal strain of the mid-myocardial and epicardial layers across all three views, were significantly decreased in the diabetes group (P < 0.05). Compared to the control group, both the normal LV geometry and LV remodeling subgroups showed significantly reduced absolute values of longitudinal strain in the epicardial layer of the 3-chamber and 4-chamber views, and in the average epicardial strain across all three views (P < 0.05), with the most pronounced changes observed in the LV remodeling group. Furthermore, compared to the control group, the LV remodeling subgroup exhibited significantly reduced absolute values of longitudinal strain in the endocardial and mid-myocardial layers of the 3-chamber view, the endocardial layer of the 4-chamber view, and the average mid-myocardial strain across all three views (P < 0.05). A significant decrease in the absolute value of epicardial longitudinal strain in the 3-chamber view was also found in the LV remodeling group compared to the normal LV geometry group (P < 0.05). The study reveals that in diabetes patients with either normal LV geometry or LV remodeling, impairment of epicardial longitudinal strain in the 3-chamber and 4-chamber views, as well as the average epicardial strain, occurs earlier. In diabetes patients with LV remodeling, longitudinal strain in the endocardial and mid-myocardial layers of the 3-chamber view, the endocardial layer of the 4-chamber view, and the average mid-myocardial strain were the most sensitively impaired parameters. Additionally, the impairment of myocardial longitudinal strain was most pronounced in the apical 3-chamber view.
VL  - 14
IS  - 1
ER  -

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Author Information

Kun Li

Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China

http://orcid.org/0000-0002-8045-1164
Jingqi Wang

Department of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China

http://orcid.org/0009-0000-7934-2780
Ling Liao

Department of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China

http://orcid.org/0009-0001-7612-6406
Chunmei Li

Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China

Contact Email

http://orcid.org/0000-0003-0537-9198

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APA Style

Li, K., Wang, J., Liao, L., Li, C. (2026). Value of Left Ventricular Layer-specific Strain in Detecting Left Ventricular Dysfunction in Diabetes Patients with Left Ventricular Remodeling and Non-remodeling. International Journal of Anesthesia and Clinical Medicine, 14(1), 21-30. https://doi.org/10.11648/j.ijacm.20261401.14

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ACS Style

Li, K.; Wang, J.; Liao, L.; Li, C. Value of Left Ventricular Layer-specific Strain in Detecting Left Ventricular Dysfunction in Diabetes Patients with Left Ventricular Remodeling and Non-remodeling. Int. J. Anesth. Clin. Med. 2026, 14(1), 21-30. doi: 10.11648/j.ijacm.20261401.14

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AMA Style

Li K, Wang J, Liao L, Li C. Value of Left Ventricular Layer-specific Strain in Detecting Left Ventricular Dysfunction in Diabetes Patients with Left Ventricular Remodeling and Non-remodeling. Int J Anesth Clin Med. 2026;14(1):21-30. doi: 10.11648/j.ijacm.20261401.14

Copy | Download

@article{10.11648/j.ijacm.20261401.14,
  author = {Kun Li and Jingqi Wang and Ling Liao and Chunmei Li},
  title = {Value of Left Ventricular Layer-specific Strain in Detecting Left Ventricular Dysfunction in Diabetes Patients with Left Ventricular Remodeling and Non-remodeling},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {14},
  number = {1},
  pages = {21-30},
  doi = {10.11648/j.ijacm.20261401.14},
  url = {https://doi.org/10.11648/j.ijacm.20261401.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20261401.14},
  abstract = {To explore the application of left ventricular (LV) stratified strain in evaluating early systolic dysfunction in diabetes patients with and without LV remodeling by using two-dimensional speckle tracking echocardiography (2DSTE), This study included 35 diabetes patients and 25 healthy individuals. All participants completed echography by GE Vivid E9 ultrasound system. The diabetes patients were subdivided based on relative wall thickness into normal LV geometry group and LV remodeling group. The EchoPAC offline workstation was used to analyze LV myocardial longitudinal layer-specific strain. Our results showed that compared to the control group, the absolute values of longitudinal strain in the endocardial, mid-myocardial, and epicardial layers of the 3-chamber view, the epicardial layer of the 4-chamber view, as well as the average longitudinal strain of the mid-myocardial and epicardial layers across all three views, were significantly decreased in the diabetes group (P < 0.05). Compared to the control group, both the normal LV geometry and LV remodeling subgroups showed significantly reduced absolute values of longitudinal strain in the epicardial layer of the 3-chamber and 4-chamber views, and in the average epicardial strain across all three views (P < 0.05), with the most pronounced changes observed in the LV remodeling group. Furthermore, compared to the control group, the LV remodeling subgroup exhibited significantly reduced absolute values of longitudinal strain in the endocardial and mid-myocardial layers of the 3-chamber view, the endocardial layer of the 4-chamber view, and the average mid-myocardial strain across all three views (P < 0.05). A significant decrease in the absolute value of epicardial longitudinal strain in the 3-chamber view was also found in the LV remodeling group compared to the normal LV geometry group (P < 0.05). The study reveals that in diabetes patients with either normal LV geometry or LV remodeling, impairment of epicardial longitudinal strain in the 3-chamber and 4-chamber views, as well as the average epicardial strain, occurs earlier. In diabetes patients with LV remodeling, longitudinal strain in the endocardial and mid-myocardial layers of the 3-chamber view, the endocardial layer of the 4-chamber view, and the average mid-myocardial strain were the most sensitively impaired parameters. Additionally, the impairment of myocardial longitudinal strain was most pronounced in the apical 3-chamber view.},
 year = {2026}
}

Copy | Download

TY  - JOUR
T1  - Value of Left Ventricular Layer-specific Strain in Detecting Left Ventricular Dysfunction in Diabetes Patients with Left Ventricular Remodeling and Non-remodeling
AU  - Kun Li
AU  - Jingqi Wang
AU  - Ling Liao
AU  - Chunmei Li
Y1  - 2026/02/26
PY  - 2026
N1  - https://doi.org/10.11648/j.ijacm.20261401.14
DO  - 10.11648/j.ijacm.20261401.14
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 21
EP  - 30
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20261401.14
AB  - To explore the application of left ventricular (LV) stratified strain in evaluating early systolic dysfunction in diabetes patients with and without LV remodeling by using two-dimensional speckle tracking echocardiography (2DSTE), This study included 35 diabetes patients and 25 healthy individuals. All participants completed echography by GE Vivid E9 ultrasound system. The diabetes patients were subdivided based on relative wall thickness into normal LV geometry group and LV remodeling group. The EchoPAC offline workstation was used to analyze LV myocardial longitudinal layer-specific strain. Our results showed that compared to the control group, the absolute values of longitudinal strain in the endocardial, mid-myocardial, and epicardial layers of the 3-chamber view, the epicardial layer of the 4-chamber view, as well as the average longitudinal strain of the mid-myocardial and epicardial layers across all three views, were significantly decreased in the diabetes group (P < 0.05). Compared to the control group, both the normal LV geometry and LV remodeling subgroups showed significantly reduced absolute values of longitudinal strain in the epicardial layer of the 3-chamber and 4-chamber views, and in the average epicardial strain across all three views (P < 0.05), with the most pronounced changes observed in the LV remodeling group. Furthermore, compared to the control group, the LV remodeling subgroup exhibited significantly reduced absolute values of longitudinal strain in the endocardial and mid-myocardial layers of the 3-chamber view, the endocardial layer of the 4-chamber view, and the average mid-myocardial strain across all three views (P < 0.05). A significant decrease in the absolute value of epicardial longitudinal strain in the 3-chamber view was also found in the LV remodeling group compared to the normal LV geometry group (P < 0.05). The study reveals that in diabetes patients with either normal LV geometry or LV remodeling, impairment of epicardial longitudinal strain in the 3-chamber and 4-chamber views, as well as the average epicardial strain, occurs earlier. In diabetes patients with LV remodeling, longitudinal strain in the endocardial and mid-myocardial layers of the 3-chamber view, the endocardial layer of the 4-chamber view, and the average mid-myocardial strain were the most sensitively impaired parameters. Additionally, the impairment of myocardial longitudinal strain was most pronounced in the apical 3-chamber view.
VL  - 14
IS  - 1
ER  -

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