Evaluation of coronary sinus strain in diabetic patients

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. It is associated with an increased risk of developing macrovascular and microvascular complications, long-term damage, dysfunction, and failure of various organs. The coronary sinus (CS) is the major coronary vein. CS is an important anatomic landmark and became the gateway for various cardiac procedures. The study and the control group had been selected among patients referred to the outpatient clinic of the Celal Bayar University Cardiology Department between 2013 and 2016. Diabetes Mellitus patients without chronic diseases(hypertension, thyroid disease, chronic inflammatory or collagen diseases or chronic pulmonary diseases) referred for transthoracic echocardiography (TTE) had been enrolled in the study group. Patients without diabetes or chronic diseases referred for TTE were assigned to control group. To the best of our knowledge, there are many studies assessing the diabetes related vascular complications on arteries but no studies investigated diabetes related complications on the venous system. This present study assessed the coronary sunus to investigate the hypothesis that venous system could be also affected as the arterial system by diabetes mellitus. The coronary sinus strain(CSS) and the dimensions were the primary parameters assessed in the study. The coronary sinus strain had been evaluated only in hypertension where it was found to be lower compared to healthy subjects (129). Our study evaluated the CSS with echocardiography to investigate the effects of diabetes mellitus on cardiac venous system. Other echocardiographic parameters were also evaluated and compared to healthy control group subjects. 49 diabetic patients and 53 healthy control subjects had been enrolled in the study. There was no statistical difference on gender but on age among the two groups.The coronary sinüs minimum values (CSMIN) were significantly different between diabetic patients and healthy controls (p: 0,004) while no significant difference was observed on coronary sinus maximal values (CSMAX) . The coronary sinüs diastolic change (CSDC) compted from these measures and the coronary sinüs strain (CSS) values were significantly different between the patients and the healthy controls. (p<0.001 and p<0.001). The results of this study support the hypothesis that diabetes mellitus may affect the cardiac venous system as well as the cardiac arterial system. Diabetic patients had significantly less strain on the coronary sinus compared to healthy control subjects on echocardiographic evaluation. These findings may suggest to perform the evaluation of cardiac venous system in all diabetic patients referred to outpatient clinics with echocardiography. Moreover, if the venous system impairments precedes the arterial system damages as in diabetic retinopathy, the evaluation of CSS may lead to more agressive glycemia control in diabetic patients with impaired cardiac venous system that would delay the arterial complications of diabetes. Larger studies evaluating the duration of the diabetes mellitus disease of the patients are necessary to confirm our results.