Evaluation Of Myocardial Work In Patients With Diabetic Nephropathy Using Left Ventricular Pressure-strain Loop Technique

Objective: The left ventricular pressure-strain loop（PSL）technique was used to quantitatively compare and analyze the myocardial work parameters of each segment in patients with diabetic nephropathy（DKD）,patients with simple type 2 diabetes（T2DM）and healthy volunteers,and to explore clinically diagnosed DKD but left ventricular ejection The left ventricular myocardial work of patients with normal LVEF fraction（LVEF）is expected to provide a new diagnostic method for early detection of abnormal cardiac function in patients with DKD,thereby improving the precise treatment and prognosis of patients.Methods: A case of Fifty-eight T2 DM inpatients and outpatients in the department of nephrology and endocrinology of Affiliated Hospital of Jining Medical University hospital from January 2021 to December 2021 they were selected and divided into T2 DM group（n=30）and T2 DM combined with DKD group（n=28）,and 29 healthy volunteers were collected as control subjects.All subjects were examined by laboratory examination and echocardiography.Those images were postprocessed by Echo Pac offline workstation,and the relevant data were measured and analyzed.The following information is obtained under the guidance of known PSL techniques: longitudinal strain peak time dispersion（PSD）,global longitudinal strain（GLS）,global useful work（GCW）,global useless work（GWW）,global work index（GWI）,The overall work efficiency（GWE）and other related indexes were compared,and whether the difference between the three groups was statistically significant.Results:1.Comparison of conventional echocardiography: normal group,DM group and DKD group decreased mitral annulus ventricular septal early diastolic velocity（e1）sequentially,while DKD group left ventricular end-diastolic septal thickness（IVSTd）,left ventricular mass（LVM）,Left ventricular mass index（LVMI）and peak mitral valve orifice blood flow velocity in late diastole（A）were higher than those in the DM group and normal group,and E/A was lower than those in the two groups.Thickness（LVPWTd）,left ventricular short-axis shortening rate（FS）,mitral valve orifice early diastolic peak blood flow velocity（E）,mitral annular lateral wall early diastolic velocity（e2）and E/e’ were higher increased than normal groups,the difference was statistically significant（P<0.01 or 0.05）.2.Comparison of global myocardial strain and myocardial work index: the normal group,the DM group and the DKD group,the global longitudinal strain（GLS）,the global useful work（GCW）,and the global work index（GWI）gradually decreased,and the longitudinal strain peak time dispersion（PSD）Compared with the DM group and the normal group,the overall useless work（GWW）of the DKD group increased gradually,and the overall work efficiency（GWE）was lower than other two groups,the difference was statistically significant（P<0.01）.Conclusion: 1.Patients with simple DM may have ventricular wall thickening and decreased short-axis shortening rate of the left ventricle on conventional two-dimensional echocardiography.The degree of ventricular wall thickening in patients with DM combined with DKD is more obvious than that in patients with simple DM,and the left ventricular The volume has also increased.2.In the evaluation of cardiac function by conventional twodimensional echocardiography,DM patients with DKD,and simple DM patients may also have diastolic function damage when the myocardial systolic function is within the normal range.3.DM patients combined with DKD will aggravate the impairment of cardiac function.Even when the ejection fraction is normal,the myocardial work index can be significantly reduced.The left ventricular PSL technology can comprehensively,accurately and intuitively evaluate the myocardial work in the early stage of the disease,and further guide the early clinical treatment and assess prognosis.