Detection Of The Left Ventricular Function In Diabetes Mellitus Using Pulsed Wave Tissue Doppler Imaging And Quantitative Tissue Velocity Imaging

Part One: Detection of the left ventricular diastolic function in diabetes mellitus using pulsed wave tissue Doppler imagingObjective: To detect the left ventricular diastolic function in diabetes mellitus (DM) using pulsed wave Doppler tissue imaging (PW-DTI) and tranditional transmitral inflow velocity E/A. Methods: Early diastolic velocity (Ve) and late diastolic velocity (Va) of posterior mitral annulus of 40 DM patients and 20 healthy subjects were obtained from apical long-axis views using PW-DTI and Ve/Va was calculated. From the same apical long-axis views, transmitral inflow velocity E and A were obtained using color Doppler flowing imaging (CDFI) , then E/A and E/Ve ratio were calculated. The DM group were divided into two subgroup: subgroup with microalbuminuria and one without microalbuminuria . The DM group was also divided into another two subgroup according to the hemoglobin A1C level (Hb A1C%). Result: The ratio Ve/Va between DM group and normal group is 0.87±0.37/1.21±0.4 and the ratio E/Ve between them is 9.24±4.47/6.03±1.72 and they are both significantly different (p<0.05). The ratio E/Ve between the group with microalbuminuria and the one without microalbuminuria is 7.36±2.46/10.5±2.49 and the ratio E/A between Hb A1C%≤7% group and Hb A1C% >7% group is 0.64±0.24/1.32±0.22 and they are both significantly different (p<0.05) too. Conclusion: PW-DTI is superior to transmitral inflow velocity E/A ratio in detecting the left ventricular diastolic function in diabetes mellitus. It will be better if they are used together.Part Two: Detection of subendocardial myocardial ischemia in diabetes mellitus using quantitative tissue velocity imagingObjective This study was performed to assess the longitudinal systolic velocity and the regional systolic myocardial velocity gradient in long-axis view by quantitative tissue velocity imaging (QTVI) and to detect whether they have subendocardial myocardial ischemia in patients with type 2 diabetes mellitus (DM). Methods Fourty-six DM patients and 23 healthy subjects were enrolled. Imagings were obtained and later analyzed from apical four chamber view (posterior septum, lateral wall), apical two chamber view (inferior , anterior wall) and apical long axis view (anterior septum, posterior wall), left ventricular parasternal long-axis view. Longitudinal peak systolic velocity (Sm) was measured at the level of mitral annulus. The subendocardial and subepicardial systolic velocity of the left ventricular posterior wall (LVPW) and interventricular septum (IVS) in the parasternal left ventricular long-axis view were measured and systolic myocardial velocity gradient (MVGs) between endocardium and epicardium were calculated . Left ventricular ejection fraction (LVEF) and the displacement of mitral annulus (Dm) were measured using M-mode ultrasound. Results (1) The LVEF and mitral annular Dm in DM group and healthy group are both at normal levels, there were no statistical difference between them. (2) The longitudinal systolic velocity of mitral annulus in diabetes mellitus patients decreased (DM group/healthy group : 6.01±1.50/6.76±1.63,P<0.001). (3) Subendocardial peak systolic velocities of IVS and LVPW decreased, while there were no statistically significant difference between diabetes mellitus and healthy groups. Compared with healthy group, the systolic MVG of IVS in diabetes mellitus was significantly lower(P<0.05), so was the systolic MVG of LVPW(DM group /normal group : IVS:-0.57±0.82/-1.1±0.50;LVPW:1.38±0.97/2.36±2.22). Conclusion This study indicates that the longitudinal systolic velocity and subendocardial peak systolic velocities and the systolic MVG of left ventricle decreased when compared with healthy group, while the left ventricular ejection fraction was normal.