Adenosine Stress Myocardial Contrast Echocardiography Detects Myocardial Microvascular Perfusion Abnormalities In Patients With Type 2 Diabetes Mellitus

BackgroundDiabetes mellitus is a metabolic disease characterized by chronic increase in blood glucose levels.In recent years,its morbidity has increased significantly.Diabetes mellitus has become an important public health problem that endangers the health of people all over the world because of its many complications,poor long-term prognosis,high disability rate and mortality.Cardiovascular disease is the most important complication and cause of death of diabetes mellitus.Studies have shown that diabetic patients often have myocardial microvascular dysfunction,which leads to decreased myocardial blood perfusion and myocardial blood flow reserve.Myocardial microvascular dysfunction and myocardial metabolic disorder are the main characteristics of early cardiac disease in diabetic patients.If the myocardial microcirculation perfusion of diabetic patients can be effectively evaluated and appropriate intervention measures can be taken,it will be of great clinical value for the early detection of diabetic patients with cardiac dysfunction and the improvement of their prognosis.Myocardial contrast echocardiography(MCE)can be qualitative and quantitative assessment of myocardial perfusion.Stress echocardiography(SE)combined with MCE can better and more comprehensive assessment of myocardial perfusion and left ventricular wall motion abnormalities.Meanwhile,it can also detect myocardial blood flow reserve and improve sensitivity and specificity of diagnosis.ObjectiveThis study intends to use adenosine stress MCE to detect left ventricular myocardial perfusion and myocardial blood flow reserve in patients with type 2 diabetes,to analyze the relationship between myocardial blood flow reserve and disease course,glycated hemoglobin in patients with diabetes,and to explore the clinical application value of this technology.MethodsA total of 26 patients with type 2 diabetes clinically diagnosed in the endocrinology department of Fuwai Central China Cardiovascular Hospital from May 2019 to January 2020 were included,as well as 28 healthy subjects with age and sex matched who were admitted to the outpatient department during the same period.Routine echocardiography,rest and adenosine stress myocardial contrast echocardiography were performed on the subjects of the two groups,respectively.The images were collected and analyzed offline.The time-intensity curve was generated to obtain the plateau signal intensity(A value),the signal intensity exchange rate(K value)and A×K value,and the myocardial blood flow reserve value was calculated.General data and conventional echocardiography parameters of all subjects were collected and analyzed statistically.The t test(independent samples t-test)was used to compare the measurement data between the two groups,and the χ2 test was used to compare the count data between the two groups.Pearson correlation test was used to analyze and compare the relationship between myocardial blood flow reserve and disease duration,glycated hemoglobin level in diabetic group.P<0.05 was considered as statistically significant.Results1.In this study,general data such as the gender,age,BMI,systolic blood pressure,diastolic blood pressure,rest and stress heart rate of two groups were compared.All these general datas was found that there was no statistical significance between the two groups(all P>0.05).2.In this study,conventional echocardiography parameters such as LVEDD,LVESD,LAD,IVST,LVPWT,LVEF value(Simpson method),E/A value and E/e’value were statistically analyzed between the diabetes group and the control group,and there was no statistical significance between the two groups(all P>0.05).3.In the rest state,the K values and A×K values of the whole and all segments of myocardial perfusion parameters in the diabetic group were significantly lower than those in the control group,with statistical significance(all P<0.05).However,there was no statistical significance in the A values of the whole and all segments of myocardial perfusion parameters in the diabetic group compared with the control group(all P>0.05).4.In the stress state,the A value,K value and A×K value of the whole and all segments of myocardial perfusion parameters in the diabetic group were significantly lower than those in the control group,with statistical significance(all P<0.05).5.The detection rate of myocardial perfusion abnormality in the stress state(42.31%)was significantly higher than that in the rest state(23.08%),and the difference was statistically significant(P<0.05).6.Pearson correlation analysis was used to statistically analyze the relationship between myocardial blood flow reserve and the course of disease and the level of glycated hemoglobin in the diabetic group.It was found that the myocardial blood flow reserve was negatively correlated with the course of disease and the level of glycated hemoglobin in the diabetic group(r=-0.580,P=0.020;r=-0.481,P=0.013).Conclusion1.In patients with type 2 diabetes mellitus,even if the cardiac function is normal by conventional echocardiography,there will be different degrees of abnormal myocardial microvascular perfusion,with diffuse changes.Adenosine stress combined with myocardial contrast echocardiography can detect left ventricular myocardial perfusion abnormality in patients with type 2 diabetes mellitus,which has important clinical application value.2.The myocardial blood flow reserve was negatively correlated with the course of disease and the level of glycated hemoglobin in patients with diabetes mellitus.With the increase of the course of disease and the deterioration of blood glucose control in patients with type 2 diabetes mellitus,the myocardial blood flow reserve decreased significantly.