| BackgroundRecently,the subclinical levels of heart dysfunction have been identified in individuals with type 2 diabetes mellitus(T2DM)without significant cardiac dysfunction and with preserved left ventricle ejection fraction(LVEF)because to improvements in diagnostic techniques.Global longitudinal strain(GLS)of the LV has been confirmed as an early sensitive marker of subclinical myocardial abnormalities and may be utilized to evaluate overall LV function by using new speckle tracking echocardiography(STE)technology.The systemic microvascular system,on the other hand,is severely harmed by prolonged exposure to hyperglycemia,which can eventually result in diabetes-related kidney disease,retinopathy,and neuropathy,which has a significant negative impact on patients’ quality of life and overall life expectancy.Moreover,carotid,as a "window" for the evaluation of major arteries throughout the body,suggests that the carotid atherosclerosis(CAS)is closely related to the risk of cardiovascular events.Nevertheless,the interplay of subclinical LV systolic function with diabetic microvascular complications and CAS is not entirely understood.The purpose of this study was to analyze the relationship between subclinical LV systolic function assessed by GLS and diabetic microvascular complications and CAS,to identify a potential clinical link between them to provide a reference for stratified early risk assessment of cardiovascular disease as well as early prevention and treatment of cardiac function in high-risk patients.ObjectiveTo investigate the relationship between subclinical LV systolic function and diabetic microvascular complications and CAS in patients with T2DM with preserved LVEF.MethodsSection 1:The subjects of this cross-sectional study were 150 T2DM patients with LVEF≥50%without overt cardiac dysfunction and coronary artery disease,who admitted to the Department of Endocrinology of our hospital from June 2021 to December 2021.All patients underwent two-dimensional(2D)STE examination.The 2D GLS was obtained to assess the subclinical systolic function of LV.LV diastolic function was evaluated by the mitral ratio of peak early to late diastolic filling velocity(E/A)and mitral velocity to early diastolic velocity of the mitral annulus(E/E’)ratio.Diabetic microvascular complications were defined as diabetic kidney disease,diabetic retinopathy or peripheral neuropathy.According to the presence of microvascular complications,the subjects were divided into three groups:no microvascular complications(n=76),1 microvascular complication(n=37)and 2～3 microvascular complications(n=37).The clinical characteristics,metabolic indicators and echocardiographic parameters of the three groups were compared.Spearman correlation analysis and Logistic regression analysis were used to assess the relationship between GLS and diabetic microvascular complications.Section 2:A total of 150 T2DM patients with LVEF≥50%from the same population as those in section 1 were selected for analysis.CAS was assessed according to bilateral carotid vascular ultrasound examination.The subjects were divided into normal carotid arteries group(n=52)and CAS group(n=98).The clinical characteristics,metabolic indicators and echocardiographic parameters were compared between the two groups.Pearson correlation analysis and Logistic regression were used to evaluate the relationship between GLS and CAS in T2DM patients.ResultsSection 1:1.The results of echocardiography showed that GLS decreased significantly as the number of microvascular complications increased[simple T2DM group vs T2DM+C(1)group vs T2DM+C(2～3)group:19.12±3.23 vs 16.93±3.61 vs 16.78±2.74,p<0.001].In contrast,the changes of E/E’ and E/A between the three groups did not reach statistical significance.Spearman analysis showed that GLS was negatively correlated with the increased number of microvascular complications(r=-0.349,p<0.001).Subgroup analysis showed that GLS in the group with peripheral neuropathy was significantly lower than that in the group without peripheral neuropathy(16.45±3.00 vs 19.15±3.21,p<0.001);Similarly,GLS of diabetic kidney disease group was lower than that of non-diabetic kidney disease group(16.98±2.66 vs 18.31 ±3.54,p=0.041),and the differences were statistically significant.In contrast,there was no significant difference in GLS between the group with retinopathy and the group without retinopathy(17.15±3.54 vs 18.14.6±3.36,p=0.215).2.Logistic regression analysis showed that,with simple T2DM group as a reference,T2DM with 1 or 2～3 types of complications were associated with decreased GLS without adjusting for any factors[OR=0.805,95%CI(0.705～0.920),p=0.001;OR=0.793,95%CI(0.693～0.907),p<0.001,respectively].After adjusting for gender and age,the correlations persisted[OR=0.785,95%CI(0.684～0.902),p<0.001);OR=0.764,95%CI(0.663～0.880),p<0.001,respectively];after further adjusting for gender,age,duration of diabetes,hypertension,glycosylated hemoglobin(HbA1c),fasting blood glucose,serum creatinine,heart rate,urinary microalbumin,and LV fraction shortening,the tight relationship between the increased burden of microvascular complications and reduced GLS still persisted independently[OR=0.744,95%CI(0.601～0.920),p=0.006;OR=0.707,95%CI(0.525～0.952),p=0.022,respectively].To further control for the potential bias of inclusion of hypertension,whether as the T2DM complicated with microvascular complications was the dependent variable,GLS as independent variable,multivariable Logistic regression analysis based on hypertension stratification showed that diabetic microvascular complications were independently associated with reduced GLS in T2DM patients with or without hypertension after adjusting for the same confounders(all p<0.05).Section 2:1.The results of echocardiography showed that no difference in GLS between carotid normal group and CAS group(carotid normal group vs CAS group:18.19±3.60 vs 17.90±3.29;p>0.05).But compared with the normal carotid artery group,E/A was decreased and E/E’ was significantly increased in CAS group(all p<0.05).Pearson correlation analysis showed that GLS was not correlated with carotid plaque thickness and carotid intima-media thickness(CIMT)(all p>0.05);E/E’ was positively correlated with the carotid plaque thickness and CIMT(all p<0.05).2.Logistic regression model analysis was performed to adjust for confounding factors including gender,age,duration of diabetes,BMI,HbAlc,hypertension,triglycerides,statins,CCBs,and metformin drugs,the result showed that GLS and E/E’ were not associated with CAS(all p>0.05).However,decreased E/A was significantly associated with the existence of CAS in T2DM patients(OR=0.121,95%CI 0.018-0.835,p=0.032).ConclusionThe LV systolic function may already be impaired in T2DM patients with preserved LVEF and microangiopathy without overt cardiac dysfunction.Subclinical LV dysfunction as assessed by GLS was significantly associated with an increased number of microvascular complications,independent of traditional cardiovascular risk factors.In addition,the presence of CAS was not associated with decreased GLS,but it was significantly associated with LV diastolic dysfunction.Therefore,it is of great significance to emphasize early risk stratification and cardiac assessment in patients with diabetic vascular complications in clinical practice for the prevention of cardiovascular events. |
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