To evaluate the left ventricular systolic function of patients with type 2 diabetes combined with microangiopathy using two dimensional speckle tracking imaging.

A total of 29 simple diabetes patients from January 2016 to December in Zhejiang Chinese Medicine University Affiliated Jiaxing Hospital of Traditional Chinese Medicine (DM group), 35 diabetes patients with microvascular disease (diabetic microangiopathy group), and 35 healthy volunteers (healthy control group) were enrolled in present study. The conventional echocardiography was used to evaluated the left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVEDS), end diastolic ventricular septal thickness (IVSDD), left ventricular posterior wall end diastolic thickness (LVPWTD), left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI). Using pulsed Doppler technique, the mitral early diastolic and late diastolic blood flow velocity ratio (E/A), E peak deceleration time (DCT), the organization of the mitral E wave velocity and the Doppler organization Doppler e' ratio (E/e) were measured. Automatic functional imaging was used to calculate the left ventricular apical axis, the four cavities of the apex, the two cavities of the apex and the overall mean longitudinal strain of the left ventricle. The clinical data, routine echocardiographic parameters and strain parameters among 3 groups were compared by one-way ANOVA. The Tukey HSD method was used to compare the differences between two groups. Pearson correlation analysis was used to analyze the correlation between the total mean longitudinal strain of left ventricle and the concentration of glycosylated hemoglobin, triglyceride concentration and systolic pressure.

Among the 3 groups, the subject age, heart rate, body mass index had no significant difference. In diabetic microangiopathy group, the glycosylated hemoglobin concentration, triglyceride, systolic blood pressure were higher than that in healthy control and diabetic groups, and the differences were statistically significant (t=16.135, 8.947; t=8.777, 10.947; t=13.806, 8.278, all P<0.05). The 3 groups had no significant differences in LVEDD, LVEDS, IVSDD, LVPWTD, DCT and LVEF. Compared with healthy controls, patients with diabetes mellitus showed decreased E/A and increased E/e; while patients with diabetic microangiopathy had decreased E/A and increased LAVI and E/e (t=13.786, 13.565; t=9.571, 11.267, 8.351, all P<0.05). In the left ventricular apical long axis view, four chamber view, two chamber view and left ventricular overall average longitudinal strain values, increasing trend was found from healthy control group, to DM group, and to diabetic microangiopathy group, and the differences between any 2 groups were statistically significant (t=5.491, 10.907, 6.076; t=4.276, 7.011, 3.250; t=10.445, 11.633, 3.683; t=10.746, 18.731, 9.532; all P<0.05). Pearson correlation analysis showed that the mean longitudinal strain value of left ventricle was negatively correlated with glycosylated hemoglobin concentration (r=-0.746, P=0.000), and there was no correlation with the triglyceride concentration and systolic blood pressure (r=0.079, P=0.438; r=0.067, P=0.416).

The two-dimensional speckle tracking imaging technique can effectively evaluate the left ventricular systolic function in patients with type 2 diabetic microangiopathy.