Quantitative Evaluation Of Myocardial Work By Non-Invasive Left Ventricular Pressure-Strain Loops In Hypertensive Patients With Type 2 Diabetes Mellitus

Objective:The purpose of this research was to evaluate the myocardial work(MW)in patients with hypertension(HT)with type 2 diabetes mellitus(T2DM)using noninvasive left ventricular pressure-strain loops(LVPSL)for evaluating accurately the patient’s condition.Another purpose was to analyze the differences in MW parameters among the control group,the simple HT group,and the HT combined with T2 DM group(HTDM group),and to find out the independent related factors of MW parameters,and to explore whether the combination of T2 DM has additional effects on the cardiac function of HT patients.Methods:A total of 100 HT patients and 40 healthy subjects who visited the First Affiliated Hospital of Nanchang University from October 2020 to December 2022 were included in the study.HT patients were divided into simple HT group(50 cases)and HTDM group(50 cases)according to the presence of T2 DM.General data of the subjects were collected,including age,height,weight,gender,fasting blood glucose(FBG),2-hour postprandial blood glucose(2h PG),glycated hemoglobin(Hb A1c),and instant systolic blood pressure(SBP)and diastolic blood pressure(DBP)were measured.After the ECG was connected,GE vivid E95 ultrasonic diagnostic instrument was used to perform routine echocardiography examination and measure parameters.At the same time,the gray-scale dynamic images of the apical four-chamber cardiotomy,the apical three-chamber cardiotomy and the apical two-chamber cardiotomy in 3 to 5 cardiac cycles,and the forward flow spectral images of the mitral and aortic valves were stored.The above image was imported into the Echo PAC analysis software(version 203)for offline analysis,and the global longitudinal strain(GLS),peak strain dispersion(PSD),global work index(GWI),global constructive work(GCW),global work waste(GWW),and global work efficiency(GWE)were obtained.Finally,the difference analysis,correlation analysis and linear stepwise regression analysis were performed on the general information,conventional echocardiographic parameters and MW parameters in the control group,simple HT group and HTDM group.Result:1.General data: In contrast to the control group,the SBP,DBP and pulse pressure(PP)of the HT group and the HTDM group were higher,and the HT duration was longer(P<0.05).In contrast to other groups,the HTDM group had higher FBG,2h PG,and Hb A1 c,and a longer T2 DM duration(P<0.05),all of which were normal differences due to inclusion criteria.In contrast to the control group,the HT group and the HTDM group had older age,higher Scr and lower estimated glomerular filtration rate(e GFR)(P<0.05).The high-density lipoprotein(HDL)of the HT group was lower than that of other groups(P<0.05).2.Conventional echocardiographic parameters: In contrast to the control group,inter ventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPWT)and left ventricular mass index(LVMI)were larger in HT group and HTDM group,while the E-peak and E/A ratio were lower(P<0.05).However,there were no distinct differences in the above parameters between the HT group and the HTDM group(P>0.05).The E/e’ ratios of rats in the control group,HT group and HTDM group were increased in sequence(P<0.05).3.MW parameters: GLS of the control group,HT group and HTDM group were decreased in sequence(P<0.05).The PSD of HT group and HTDM group were higher than that of the control group(P<0.05),but there was no distinct difference between HT group and HTDM group(P>0.05).In contrast to other groups,the GWI of HT group was higher(P<0.05),but there was no distinct difference between the control group and HTDM group(P>0.05).The GCW of the HTDM group was lower than that of the HT group alone(P<0.05),but there was no distinct difference between the control group and HTDM group(P>0.05).The GWW of the control group,HT group and HTDM group was increased in sequence(P<0.05),while the GWE was decreased in sequence(P<0.05).4.Correlation and regression analysis: Age,SBP,DBP,PP,FBG,2h PG,Hb A1 c,the T2 DM duration,the HT duration,Scr,and e GFR were correlated to varying degrees with myocardial strain and MW parameters.SBP,DBP,Hb A1 c,and the T2 DM duration were the independent related factors of GWI and GCW.SBP and Hb A1 c were independent related factors of GWW,while Hb A1 c and the HT duration were independent related factors of GWE.Conclusion:1.Non-invasive LVPSL has a unique advantage in the assessment of left ventricular systolic function,and can quantitatively assess the myocardial work of HT patients with T2 DM.2.Non-invasive LVPSL found that the cardiac function damage of HT patients with T2 DM was more obvious than that of simple HT patients,suggesting that combination of T2 DM may cause additional damage to the cardiac function of HT patients.3.SBP,DBP,Hb A1 c,the duration of T2 DM and HT may be independent relevant factors of MW parameters,and SBP and Hb A1 c are the most important independent relevant factors.4.The increases in GWI and GCW caused by high SBP may mask the cardiac function impairment caused by the disease.When applying LVPSL,attention should be paid to distinguish the effects of afterload.