Dual-source CT Functional Imaging Of Cardiomyopathy And Coronary Artery Disease In Patients With Type2Diabetes

Part one:Dual-source CT functional imaging of cardiomyopathy in patients with type2diabetesObjectsIt is aim to provide datas and evidences for further prevention and remedy by evaluating the feasibility with dual-source CT (DSCT) in the assessment of cardiomyopathy in patients with type two diabetes, analysing the risk factor which are involved in regulating the changes of left ventricular structure、function.Materials and Methods58cases of patients with type two diabetes (T2DM)(47males,11females, aged28～80years with a mean of (56.52±10.05),42cases of patients with T2DM and essential hypertension (EH)(26males,16females, aged42～71years with a mean of (58.55±9.28),42cases of normal subjects (32males,10females, aged42～71years with a mean of (54.19±7.29) were enrolled. All patients were subjected to coronary angiography using dual-source CT (Somatom Definition, Germany, Siemens). All measurements were performed at the level of the chordae according to the international recommendations for chamber quantification in echocardiography. Short-axis MPR at end-diastole was used for wall thickness measurement of the interventricular septum (ISTdia) and posterior wall (PWTdia). Short-axis MPR at end-systole was used for wall thickness measurement of the interventricular septum (ISTsys) and posterior wall (PWTsys). Left ventricular inner diameter in end-diastole (LVIDdia) and end-systole (LVIDsys) were measured in the four-chamber MPR. Left atria anterior posterior diameter in end-systole (LADsys) was measured on axial oblique MPR through the level of the aortic valve and parallel to the LV outflow tract in a strictly anterior-posterior orientation. Confluences of pulmonary veins were excluded. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), cardiac output (CO), left ventricular ejection fraction (LVEF), left ventricular myocardial mass (LVMM), cardiac index (CI) and body surface area (BSA) were calculated directly using the left ventricular analysis software, left ventricular mass index (LVMI) was calculated using the formula:LVMI=LVMM/BSA.Results1.There were no significant differences in age、gender、height、weight and heart rate among the control group-. pure T2DM group and T2DM+EH group (P>0.05). BMI、DBP and SBP in T2DM+EH groups were greater than T2DM group and control group, there were no significant differences of them between the other groups.The ration of smoking was greatst in T2DM group and lowest in the control group with statistical significance, while the other three groups had no significant difference(χ2=6.951, P=0.031).The incidence of hyperlipemia was significantly highest in T2DM+EH group, lowest in control group (χ2=9.419, P=0.009).2.Comparing the indicators of left ventricular structure,we found there were no significant differences in LVIDsys, LVIDdia among the control group, pure T2DM group and T2DM+EH group (P>0.05). PWTdia、PWTsys、ISTdia、ISTsys、LADsys and LVMI were greatest in T2DM+EH group and lowest in the control group with statistical significance (P=0.000). 3.Comparing the indicators of left ventricular function, we found LVMM was greatest in T2DM+EH group and lowest in the control group, there were no significant differences in EF、EDV、ESV、SV、CO and CI among the control group, pure T2DM group and T2DM+EH group (P>0.05), which represent the left ventricular systolic function.4.There were no significant differences in EF, CO、ESV、EDV、STROKE、 CI、BSA、ISTsys、LVIDsys and LVIDdia between the pure T2DM group and T2DM+EH group (P>0.05); LVMM、LVMI、ISTdia、PWTsys、PWTdia and LADsys in T2DM+EH group were significantly greater than pure T2DM group(P<005). The indicators represent left ventricular structure(LVIDsys、LVIDdia、ISTsys、ISTdia、PWTsys、PWTdia、 LVMM and LVMI) were not different significantly between elderly patients and young patients、long-term group and short-term group (P>0.05). SV、EDV were different between elderly patients and young patients, the difference was significant statistical sense (the value of P were0.026and0.040), while LVEF、ESV、CO and CI were not different significantly between them. The LVEF in long-term group was significantly lower than short-term group(P=0.039),while ESV、EDV、CO、SV and CI were not different significangtly between them (P>0.05). In correlation analysis, LADsys was positively correlated with the BMI (r=0.428, P=0.000)、SBP (r=0.401, F=0.000)、EDV (r=0.373, P=0.000)、ESV (r=0.217, P=0.000); A further linear stepwise regression analysis indicated that LADsys was independently associated with age.BMI、SBP、EDV and gender (R2=0.500, P=0.000). In correlation analysis, LVMI was positively correlated with the glycosylated hemoglobin (r=0.385, P=0.000), SBP (r=0.231, P=0.000)、LVIDdia (r=0.283, P=0.004) and LVIDsys (r=0.395, P=0.000); A further linear stepwise regression analysis indicated that LVMI was independently associated with LVIDsys、glycosylated hemoglobin、SBP and gender.Conclusion 1. DSCT is an effective and novel modality to assess the cardiomyopathy in patients with T2DM and can provide one-stop noninvasive evaluation of cardiac morphology, function.2. DSCT can assess the left ventricular diastolic dysfunction in patients with T2DM who have enlargement of left atrium diameter by measuring LADsys, which is an important symbol of the left ventricular diastolic dysfunction.3. The changes of the left ventricular in patients with T2DM including left ventricular mild dilation、significant myocardial hypertrophy and the presence of an increased left ventricular mass.4. The ageing process has a cumulative effect of impaired left ventricular function, along with type2diabetes mellitus course of diseases prolonged, the systolic dysfunction of left ventricular becomes more pronounced.5. Hypertension can aggravate impaired left ventricular structure and function significantly.6. Both glycosylated hemoglobin blood pressure (primarily SBP) and other multiple risk factors of cardiovascular disease are involved in the progress of LV remodeling in patients with T2DM. Part two:Dual-source CT Imaging Study of Type Two Diabetes Mellitus Patients with Coronary Artery DiseaseObjectsIt is aim to provide datas and evidenees for further prevention and remedy by observing the characteristies of coronary artery disease (CAD) in patients with type2 diabetes mellitus with dual-source CT (DSCT) and analyze the risk factors which may lead to CAD.Materials and Methods48cases of T2DM patients with CAD (T2DM group)(43males,5females, aged29～80years with a mean of (59.67±10.29) and44cases of non-T2DM patiens with CAD (non-T2DM group)(34males,10females, aged33～79years with a mean of (59.82111.29) were enrolled. The T2DM group had25patients with essential hypertension (EH), while18cases in non-T2DM group. All patients were subjected to coronary angiography using dual-source CT (Somatom Definition, Germany, Siemens). Each coronary artery was analysed at best-diastole and best-systole phase.The value of Kernal was B26F, thickness was0.75mm, reconstructing space was0.5mm. All images were transferred to the Syngo workstation to analyse and and processed by Circulation software, including volume rendering (VR)、curved planar reformation (CPR) and maximum intensity projection (MIP). The numbers of involved coronary arteries were calculated according the degree of stenosis was more than50%in LM、LAD、LCX and RCA.The number of diseased coronary arteries were divided into one artery involed、two arteries involed、three arteries involed and more than three arteries involed (LM involed was considered as two arteries involed); The judgment of coronary artery diffuse lesion was based on the United States ACC/AHA coronary morphology classification standard in1988:target lesion length is more than20mm or there were3or more than3vascular stenosis in at least more than the length of1/3coronary artery.The plaque was defined by the CT attenuation value:CT attenuation value>130HU was defined as calcification plaque(CP); CT attenuation value<130HU but higher than epicardial adipose tissue was defined as soft coronary atherosclerotic plaque (SP); The plaque also included CP and SP was defined as mixed plaque (MP).The cornary arteries in T2DM group and non-T2DM group were analyzed according the above standards.Results1. The level of fasting plasma glucose (FPG) in T2DM group was significantly higher than non-T2DM group (P=0.000),There were no significant differences in age、sex、prevalence of hypertension、prevalence of hyperlipemia、smoking、body mass index and blood pressure level between the T2DM group and the non-T2DM group (P>0.05).2. The incidence rate of three coronary arteries and incidence rate of more than three coronary arteries in T2DM group were31.25%、20.83%,while in non-T2DM group were20.45%、4.5%, which have significant difference between them(P<0.05); The incidecen of coronary artery diffuse lesions in T2DM group was significantly higher than that of non-T2DM group (P<0.001); The ration of coronary artery disease in T2DM group was higher than non-T2DM group without statistical significance (P>0.05).3.The location of stenosis were as follows with statistical significance:LAD (95.8%)>RCA (60.4%)>LCX (47.9%)>LM (27.1%)(P=0.000). It is aim to observe the relationship of T2DM course and the numbers of involved coronary arteies by dividing the T2DM patients into three groups according the course, there was significantly different among them (P=0.001). It is aim to observe the relationship of the numbers of involved coronary arteies and FPG、glycosylated hemoglobin levels、 prevalence of hyperlipemia and plaque by dividing the T2DM patients into four groups according the numbers of involved coronary arteies, There were no statistical differences in FPG、prevalence of hyperlipemia and plaque among the four groups, while there was statistical differences in glycosylated hemoglobin levels among the four groups. 4. Enter logistic regression analysis was established with age、body mass index (BMI)、smoking、DBP、SBP、Total cholesterol (TC)、 low density lipoprotein cholesterin(LDL)、high density lipoprotein cholesterin (HDL)、LDL/HDL、FBG、 glycosylated hemoglobin and T2DM course as independent variable, with the occurrence of CAD as dependent variable, the occurrence of CAD was independently associated with smoking、glycosylated hemoglobin、T2DM course and LDL/HDL (P<0.05), the judgement accuracy reaches72.1%.Conclusions1. DSCT is an effective and novel modality to assess the stenosis and plaques by higher time resolution retrospective electrocardiogram (ECG)-editing technique and strong post image process function.2. T2DM patients with CAD have higher possibility of multivessel disease and diffuse lesions and LAD was the most common site of stenosis.3.Smoking、glycosylated hemoglobin、T2DM course and LDL/HDL were the independent risk factor of the occurrence of CAD in T2DM patients.