Evaluation of potential left ventricular systolic dysfunction in patients with type 2 diabetes mellitus using ultrasonic myocardial work technology

doi:10.3877/cma.j.issn.1672-6448.2023.10.005

Abstract

Abstract:

Objective

To evaluate the abnormal changes of potential left ventricular myocardial systolic function and synchronization in patients with type 2 diabetes mellitus (T2DM) with and without obesity by applying myocardial work technique, and to investigate the clinical application of myocardial work parameters in assessing left ventricular systolic function in patients with T2DM.

Methods

A total of 70 patients with T2DM attending the endocrine outpatient clinic of Sichuan Provincial People's Hospital from December 2020 to August 2021 were selected and divided into two groups according to body mass index (BMI): 32 cases with T2DM not combined with obesity (BMI<25 kg/m²) and 38 cases with T2DM combined with obesity (BMI≥25 kg/m²). Forty-two age- and gender-matched healthy physical examiners were selected as a control group during the same period. All the three groups underwent conventional echocardiography to obtain left ventricular configuration and function parameters, and at the same time, speckle tracking and myocardial work techniques were used to obtain the global longitudinal strain (GLS), peak strain dispersion (PSD), global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE). The differences in the above parameters were compared among the three groups of parameters.

Results

The left ventricular ejection fraction (LVEF) decreased sequentially in the normal control group, the T2DM without obesity group, and the T2DM with obesity group, but the differences were not statistically significant (P>0.05). Compared with the normal control group, GLS, GCW, GWI, and GWE were decreased and GWW was increased in the other two groups. Compared with T2DM patients without obesity, GCW and GWE in T2DM patients with obesity were decreased significantly (P<0.05). Compared with the normal control group, PSD was significantly increased in T2DM patients with obesity (P<0.05).

Conclusion

Left ventricular myocardial systolic function may have already been impaired in T2DM patients with normal LVEF, and obesity may aggravate such impairment. Myocardial work parameters can more sensitively evaluate potential left ventricular systolic function impairment. Myocardial work technique could be used as an innovative method to evaluate left ventricular systolic function in T2DM patients with normal ejection fraction.

Key words: Myocardial work, Type 2 diabetes mellitus, Echocardiography, Obesity, Left ventricular function

Jinmei He, Lixue Yin, Jing Tan, Wenjun Zhang, Rui Wang, Mei Ren, Mingjiao Liao. Evaluation of potential left ventricular systolic dysfunction in patients with type 2 diabetes mellitus using ultrasonic myocardial work technology[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1029-1035.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2023.10.005

https://chaosheng.cma-cmc.com.cn/EN/Y2023/V20/I10/1029

Figures/Tables 10

References 20

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临床资料	对照组（n=42）	T2DM不合并肥胖组（n=32）	T2DM合并肥胖组（n=38）	统计值	P值
年龄（岁）	41.83±11.44	47.19±9.07	46.47±11.05	F=2.88	0.061
男性[例（%）]	23（54.8）	25（78.1）	28（73.7）	χ^²=5.44	0.066
身高（cm）	164.50±7.14	168.06±7.01	165.45±16.02	F=5.35	0.069
体重（kg）	60.00±7.40	67.25±18.58	72.74±5.95^ab	F=41.74	<0.001
收缩压（mmHg）	115.62±6.28	120.13±6.60^a	120.95±9.00^a	F=14.21	<0.001
舒张压（mmHg）	73.50±7.17	75.97±6.28	76.42±6.35	F=2.23	0.113
心率（次/分）	72.31±9.14	78.44±10.48^a	81.79±12.36^a	F=15.58	<0.001
BMI（kg/m²）	22.13±1.86	22.63±1.69	25.82±0.80^ab	F=75.35	<0.001
FPG（mmol/L）	4.50±0.28	9.67±1.60^a	9.61±1.58^a	F=78.16	<0.001

临床资料	对照组（n=42）	T2DM不合并肥胖组（n=32）	T2DM合并肥胖组（n=38）	统计值	P值
年龄（岁）	41.83±11.44	47.19±9.07	46.47±11.05	F=2.88	0.061
男性[例（%）]	23（54.8）	25（78.1）	28（73.7）	χ^²=5.44	0.066
身高（cm）	164.50±7.14	168.06±7.01	165.45±16.02	F=5.35	0.069
体重（kg）	60.00±7.40	67.25±18.58	72.74±5.95^ab	F=41.74	<0.001
收缩压（mmHg）	115.62±6.28	120.13±6.60^a	120.95±9.00^a	F=14.21	<0.001
舒张压（mmHg）	73.50±7.17	75.97±6.28	76.42±6.35	F=2.23	0.113
心率（次/分）	72.31±9.14	78.44±10.48^a	81.79±12.36^a	F=15.58	<0.001
BMI（kg/m²）	22.13±1.86	22.63±1.69	25.82±0.80^ab	F=75.35	<0.001
FPG（mmol/L）	4.50±0.28	9.67±1.60^a	9.61±1.58^a	F=78.16	<0.001

超声参数	对照组（n=42）	T2DM不合并肥胖组（n=32）	T2DM合并肥胖组（n=38）	F 值	P值
LVPWT（mm）	7.74±1.08	8.72±1.17^a	8.71±1.43^a	16.44	<0.001
LVEDD（mm）	43.33±4.78	42.91±3.51	43.79±4.30	0.40	0.820
LVESD（mm）	24.24±3.65	24.28±3.02	25.16±4.36	0.97	0.617
IVST（mm）	6.74±1.08	7.44±1.22^a	7.53±0.98^a	12.14	0.002
LAD（mm）	26.81±3.18	25.53±3.22	27.00±3.81	3.76	0.152
LVEDV（ml）	74.12±17.01	73.09±15.40	73.11±21.95	0.57	0.752
LVESV（ml）	28.14±10.49	28.16±9.09	30.21±12.33	0.64	0.727

超声参数	对照组（n=42）	T2DM不合并肥胖组（n=32）	T2DM合并肥胖组（n=38）	F 值	P值
LVPWT（mm）	7.74±1.08	8.72±1.17^a	8.71±1.43^a	16.44	<0.001
LVEDD（mm）	43.33±4.78	42.91±3.51	43.79±4.30	0.40	0.820
LVESD（mm）	24.24±3.65	24.28±3.02	25.16±4.36	0.97	0.617
IVST（mm）	6.74±1.08	7.44±1.22^a	7.53±0.98^a	12.14	0.002
LAD（mm）	26.81±3.18	25.53±3.22	27.00±3.81	3.76	0.152
LVEDV（ml）	74.12±17.01	73.09±15.40	73.11±21.95	0.57	0.752
LVESV（ml）	28.14±10.49	28.16±9.09	30.21±12.33	0.64	0.727

超声参数	对照组（n=42）	T2DM不合并肥胖组（n=32）	T2DM合并肥胖组（n=38）	F 值	P值
E（cm/s）	87.93±18.32	75.38±15.71^a	75.68±13.15^a	7.90	0.001
A（cm/s）	71.40±15.27	73.56±18.08	84.37±17.30^ab	6.59	0.002
E/A	1.31±0.45	1.07±0.36^a	0.95±0.25^a	20.06	<0.001
e（cm/s）	14.02±2.51	11.28±2.98^a	10.53±2.44^a	19.60	<0.001
a（cm/s）	10.95±1.75	10.66±1.36	11.37±1.78	2.10	0.350
e/a	1.31±0.38	1.13±0.40	0.96±0.31^a	19.65	<0.001
E/e	6.39±1.23	6.91±1.72	7.46±1.78^a	7.99	0.018

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