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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Albuminuria is independently associated with preclinical left ventricular systolic dysfunction: The TESEO study
Federica Barutta, Alessandro Andreis, Matteo Bellettini, Guglielmo Beccuti, Arianna Ferro, Martina Bollati, Stefania Bellini, Giulia Gioiello, Giulio Mengozzi, Gaetano M De Ferrari, Gianluca Alunni, Fabio Broglio, Gabriella Gruden
Federica Barutta, Alessandro Andreis, Matteo Bellettini, Guglielmo Beccuti, Arianna Ferro, Martina Bollati, Stefania Bellini, Giulia Gioiello, Giulio Mengozzi, Gaetano M De Ferrari, Gianluca Alunni, Fabio Broglio, Gabriella Gruden, Department of Medical Sciences, University of Turin, Turin 10126, Italy
Alessandro Andreis, Gaetano M De Ferrari, Division of Cardiology, Città della Salute e della Scienza di Torino, Turin 10126, Italy
Alessandro Andreis, Gianluca Alunni, Advanced Cardiovascular Echocardiography Unit, Department of Cardiovascular and Thoracic, Città della Salute e della Scienza di Torino, University Hospital, Turin 10126, Italy
Co-first authors: Federica Barutta and Alessandro Andreis.
Author contributions: Barutta F and Andreis A analyzed the data and wrote the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Bellettini M, Beccuti G, Ferro A, Bellettini M, Bellini S, and Gioiello G performed research; Mengozzi G, De Ferrari GM, Alunni G, and Broglio F reviewed and edited the manuscript; Gruden G designed and directed the study, wrote the manuscript, had access to all data, and is responsible for the integrity of the data and the accuracy of the data analysis; and all authors have read and approved the final manuscript.
Supported by the Italian Ministry for Education, University and Research under the Programme “Dipartimenti di Eccellenza 2018-2022” Project, No. D15D18000410001; and Novo Nordisk “Gestione delle complicanze croniche del diabete: From bedside to bench?”, No. n1/2021.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the City of Health and Science of Turin, approval No. D15D18000410001.
Clinical trial registration statement: The clinical trial statement is not applicable as this study is not a clinical trial.
Informed consent statement: All participants provided written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Federica Barutta, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin 10126, Italy.
federica.barutta@unito.it
Received: March 11, 2025
Revised: May 7, 2025
Accepted: August 4, 2025
Published online: September 15, 2025
Processing time: 185 Days and 0.4 Hours
BACKGROUND
Global longitudinal strain (GLS) of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction (EF) in detecting preclinical left ventricular systolic dysfunction (LVSD). In patients with type 2 diabetes (DM2) albuminuria is a predictor of symptomatic heart failure, but data on the relationship between GLS and albuminuria are conflicting.
AIM
To explore the relationship between GLS and albuminuria in a contemporary cohort of DM2 patients.
METHODS
The study was performed on DM2 patients consecutively enrolled in the TESEO study. Patients with symptoms/signs of heart failure, EF < 50%, coronary artery, other cardiac diseases, or non-adequate acoustic window for GLS assessment were excluded. We collected clinical data, screened for complications, and measured GLS by speckle-tracking echocardiography. Univariate and multiple linear regression analyses were performed to identify independent explanatory variables associated with GLS. Logistic regression analysis was used to assess whether albuminuria was independently associated with GLS-diagnosed (GLS > -18%) LVSD.
RESULTS
Patients (n = 193, age: 60.6 ± 8.1, male: 57%) had a short DM2 duration (3.8 ± 4.9 years) and good metabolic control (glycated haemoglobin A1c: 6.5% ± 1.0). Preclinical GLS-LVSD was present in 21.8% of the patients. GLS values were significantly higher in patients with albuminuria (-19.88 ± 2.16 vs -18.29 ± 2.99, P < 0.001) and in multivariate analysis natural logarithm of albumin-creatinine ratio and uric acid were independent predictors of GLS. In logistic regression analysis, albuminuria was associated with a 6.01 (95% confidence interval: 1.874-19.286) increased odds ratio of GLS-LVSD, independent of age, sex, diastolic blood pressure, chronic kidney disease, EF, mitral annulus velocity lateral, uric acid, and treatments.
CONCLUSION
Albuminuria was independently associated with subclinical LVSD in our contemporary cohort of DM2 patients.
Core Tip: This study provides evidence that the prevalence of preclinical global longitudinal strain-left ventricular systolic dysfunction was elevated in type 2 diabetic patients despite the short duration of the disease and that albuminuria was independently associated with a 6-fold increased risk of preclinical global longitudinal strain-left ventricular systolic dysfunction. Our results suggest that albuminuria may help identify individuals with pre-heart failure who might benefit from an early intervention to prevent/delay heart failure development.
