Evaluation Of Early Cardiac Systolic Function Damage And Myocardial Mechanics In Patients With Prediabetes Based On Speckle Tracking Imaging Technique

Part Ⅰ Evalution of left systolic function and synchrony in patients with prediabetes and diabeties mellitues by two-dimensional speckle tracking techniqueObjective:To investigate the clinical value of two-dimensional speckle-tracking technique(STI)in evaluating left ventricular systolic function and synchronization in patients with prediabetes and type 2 diabetes mellitus(T2DM)with preserved left ventricular ejection.Methods:Forty-three patients with prediabetes,62 patients with T2 DM,and 50 healthy volunteers were selected as study subjects,The global systolic longitudinal strain(GLS),peak strain time dispersion(PSD),left ventricular endocardial myocardial longitudinal strain(LSEndo),mid-layer myocardial longitudinal strain(LSMid)and epicardial longitudinal myocardial strain(LSEpi)were measured by two-dimensional speckle tracking technique(2D-STI)and stratified strain technique.The differences of strain parameters and peak time dispersion of the three groups were compared.Reproducibility of global and layer-specific longitudinal strain parameters in the left ventricle was analyzed by intraclass correlation coefficient(ICC)and Bland-Atlman concordance.Independent predictors of global longitudinal strain in the left ventricle were analyzed by univariate and multivariate regression models.Results:(1)LVGLS decreased gradually in control group,prediabetic group and diabetic group,and there was statistically significant difference between control group and other two groups(22.24±1.52% vs.19.95±2.56% vs.17.74±1.98%,P<0.001),but there was no statistically significant difference between diabetes group and prediabetes group.(2)LSEndo in control group,prediabetic group and diabetic group decreased in turn,and there were statistically significant differences among the three groups(25.75±1.62% vs.24.39±3.39% vs.21.77±2.80%,P<0.001).LSMid and LSEpi only showed statistically significant difference between diabetes group and other two groups,but there was no statistically significant difference between prediabetic group and control group.(3)PSD in control group,prediabetic group and diabetes group increased gradually,and that in diabetes group and prediabetes group was higher than that in control group,and the difference was statistically significant(37.48±7.11 ms vs.45.62±16.62 ms vs.48.90±18.51 ms,P<0.05),but there was no significant difference between prediabetic group and diabetic group.(4)Bland-Altman analysis showed intra-and interobserver ICC ranges of 0.952 to0.976,0.948 to 0.964 for the global and layered-specific longitudinal strains of the left ventricle.(5)Glycosylated hemoglobin(Glycosylated Hemoglobin,Type A1 C,Hb A1c),diastolic blood pressure,BMI(Body mass index)and gender were independent predictors of LVGLS.Conclusion:There is still a risk of decreased left ventricular systolic function in prediabetic and diabetic patients with preserved left ventricular ejection fraction.The application of 2D-STI and layer-specific strain technique can detect subtle changes in left ventricular systolic function in prediabetic and diabetic patients.Hb A1 c,diastolic blood pressure,body mass index,and gender are independent predictors of LVGLS.2D-STI provide objective imaging basis for early diagnosis and early intervention of prediabetes and diabetes mellitus.Part Ⅱ Evalution of early right ventricular systolic function in patients with prediabetes and type 2 diabetes mellitus by two-dimensional speckle tracking techniqueObjective : The purpose of this study was to evaluate the clinical value of two-dimensional speckle tracking technique in prediabetic and diabetic patients with preserved left ventricular ejection fractionMethods: The study included 43 patients with prediabetes,52 patients with T2 DM and 49 healthy volunteers as control group.All subjects had normal LVEF(≥50%),Conventional echocardiography and 2DSTI were performed,tricuspid annular plane systolic excursion(TAPSE),tissue Doppler-derived tricuspid annular systolic velocity(TV-S’),RV fractional area change(FAC),left ventricular global longitudinal strain(LVGLS),right ventricular global longitudinal strain(RVGLS),and right ventricular free wall strain(RV-FWLS)measurements were measured.The parameters of right ventricular systolic function among groups were compared,and the correlation between RVGLS and general clinical data and conventional echocardiographic parameters was analyzed.Intraclass correlation coefficient(ICC)and Bland-Atlman concordance were used to analyze the reproducibility of right ventricular longitudinal strain parameters.Independent predictors of global longitudinal strain in the right ventricle were analyzed by univariate and multivariate regression models.Results:(1)RV-FAC was statistically lower in both the prediabetes and diabetes groups than in the control group(55.14±5.61% vs.51.79±6.11% vs.51.48±6.94%,P<0.05),but there was no statistical difference between the prediabetes and diabetes groups.TAPSE was only statistically different between the control and diabetes groups(20.76±2.73 mm vs.20.49±2.51 mm vs.19.29±2.52 mm,P<0.05),and TV-S’was not statistically different between all three groups.(2)RVGLS gradually decreased from the control group to the diabetes group,and the statistical signicance was observed on the RVGLS among the three groups(20.80±1.96% vs.18.99±3.20%vs.16.85±4.01%,P<0.001).The RV-FWLS of the control group was higher than that of the prediabetes group and the diabetic group,and the difference was statistically significant(25.63±4.58% vs.22.83±4.83% vs.20.79±4.92%,P<0.05),but there was no statistically significant difference in RV-FWLS between the prediabetic group and the diabetic group.There was significant difference in interventricular septal longitudinal strain(IVS-LS)only between the control group and diabetic group(17.28±2.35% vs.16.14±3.22% vs.15.53±3.33%,P<0.05).(3)Right ventricular myocardial strain parameters was well reproducible,and Bland-Altman analysis yielded intra-and interobserver ICC ranges of 0.878 to 0.902,0.856 to 0.866 for RVGLS and RV-FWLS.(4)Hb A1 c,IVS-IS and LVEDd were independent predictors of RVGLS.Conclusion: Abnormally elevated hyperglycemia has a negative effect on right ventricular myocardial function,and the mechanism may be related to left ventricular remodeling and myocardial strain reduction.Two-dimensional speckle tracking echocardiography can detect subtle changes in early right ventricular systolic function.Hb A1 c,interventricular septal strain and left ventricular end-diastolic diameter are independent risk factors for RVGLS.Part Ⅲ Three-dimensional speckle tracking technique was used to visually evaluate the changes of left ventricular myocardial mechanics in prediabetic and type 2 diabetic patients with preserved ejection fractionObjective: To verify the feasibility and accuracy of 3D speckle tracking technique for assessing left ventricular systolic function and to explore the clinical application value of 3D-STI for evaluating myocardial mechanical alterations in prediabetic and diabetic patients with preserved ejection fraction.Methods: Thirty-three prediabetic patients,42 diabetic patients and 33 healthy volunteers were selected as study subjects.The global longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS),global area strain(GAS)were measured by 3D-STI,and two-dimensional left ventricular longitudinal strain and two-dimensional left ventricular circumferential strain were measured by2D-STI.Reproducibility of 3D-STI LV global strain parameters was analyzed by intraclass correlation coefficient(ICC)and Bland-Atlman concordance.The receiver characteristic curve(ROC)was constructed to determine the clinical diagnostic value of 3D-STI in evaluating subclinical left ventricular insufficiency in patients with prediabetes and type 2 diabetes.Results:(1)Base on the analysis of 3D-STI,the results showed that GLS of control group,prediabetic group and diabetic group were(18.40±1.97% vs.14.53±2.14% vs.13.36±2.57%),GCS were(18.09±2.37% vs.13.88±2.10% vs.12.81±2.29%),GAS were(31.30±3.88% vs.26.12±3.57% vs.24.67±3.86%),the values of GLS,GCS and GAS in prediabetic group and diabetic group were significantly lower than that in control group(P<0.05),but there was no significant difference between prediabetes group and diabetes group.The values of GRS decreased from the control group to the diabetes group(49.18±5.91% vs.39.27±4.93% vs.35.69±7.02%),and there was statistical significance among the three groups(P<0.001).(2)Bland-Altman analysis showed intra-and interobserver ICC ranges of 0.963 to 0.981 and 0.956 to 0.985 for GLS,GCS,GAS,and GRS groups.(3)The area under the curves of 3D-STI global strain paremeters(GLS,GCS,GAS,GRS)were 0.898,0.831,0.863 and 0.868,and the areas under the curves of2D-STI global strsin paremeters(GLS,GCS)were 0.867 and 0.636,respectively.Conclusion: 3D-STI left ventricular global strain parameters(GLS,GAS,GCS and GRS)are sensitive parameters of myocardial mechanics in prediabetic and diabetic patients,and can be sensitive diagnostic indicators for early detection of subclinical LV systolic insufficiency.3D-STI global strain parameter are reproducible and have a high diagnostic value in assessment of subclinical LV insufficiency in prediabetic and diabetic patients.Therefore,3D-STI is a reliable imaging technique for the evaluation of early LV myocardial mechanical damage.