| In recent years,the incidence of metabolic disease,especially type II diabetes is constantly growing worldwide.The impact of diabetes and various complications caused by diabetes on public health is becoming more and more obvious.Marked alterations in the vascular system have been recognized in diabetic population and are classified as micro-and macro-vascular defects.While heart disease in diabetes is mainly due to macro-vascular damage,accumulating evidence suggests that small vessel disease also plays a significant role in the genesis of cardiac dysfunction in diabetic subjects[1].The cardiac synchronization is the necessary condition to ensure the normal cardiac systolic and diastolic function.It is also the necessary condition to guarantee the heart can pump blood as normal.The normal heart should be ensured harmonious orderly systolic-diastolic motion,but when some segmental myocardial motion occurs advance or delay,the heart is in dyssynchronization.Because of some segmental myocardial dyssynchronization,the left ventricular can not effectively eject,so the ejection fraction and cardiac output are declined.Tissue synchronization imaging(TSI)technology belongs to the category of tissue Doppler imaging(TDI).It can be used to evaluate left ventricular synchrony and not only can visually show the segmental myocardial of dyssynchrony but also can give quantitative parameters of asynchrony.TSI is a kind of new technology which has the advantages of simple operation to evaluate left ventricular synchrony.Objective: Using the tissue synchronization imaging to study the left ventricular synchronization of 2 type diabetes mellitus and observing with the development of diabetic microangiopathy,the effect of it on the cardiac synchronicity.Methods: Choosing 60 patients with Type 2 Diabetes Mellitus in Department of Endocrinology of Hebei General Hospital between November 2014 and December 2015.All patients meet the diagnostic criteria for WHO diabetes in 1999.First diagnosis course of 5 years or more.According to whether with or without diabetic microangiopathy,these patients were classified as two groups: thirty people without diabetic microangiopathy(T2DM1:15 cases of male,15 cases were female,age 30~66,the average age 45.43 ± 9.21)while thirty people with diabetic microangiopathy(T2DM2:15 cases of male,15 cases were female,age 30~62,the average age 48.07±7.34).All of the patients had sinus rhythm,QRS complexes duration<120ms,no arrhythmia and bundle branch block.The case group underwent echocardiography.The case group's ejection fraction was normal(EF>50%),no severe heart valve disease,congenital heart disease.According to the clinical physical examination and laboratory examination,the patients with essential hypertension and primary cardiomyopathy were excluded.All of the patients had no history or symptoms of coronary heart disease.Some patients can provide the results of coronary angiography to prove that they have no coronary heart disease.Thirty healthy volunteers were chosen as the normal group(NC group:15 cases of male,15 cases were female,age 27~65,the average age 43.27±8.89).All of the volunteers were healthy in the past.They were found that have no significant abnormality in the ECG,echocardiography,clinical physical examination and laboratory examination.Instrument and equipment: Using the ultrasound diagnostic instrument,Vivid E9,which is produced by the General Electric Company.The instrument was equipped with M5 S probe,frequency 2.5~5.0MHz.A digital workstation was installed with software for image analysis and postprocessing such as tissue synchronization imaging.Operation process: Making the patients in the left lateral recumbent position and having quiet breath.The patients were connected synchronous ECG.Using the conventional echocardiography to measure the left atrial diameter,the interventricular septal thickness,the left ventricular posterior wall thickness,the left ventricular end-systolic diameter,the left ventricular end-diastolic diameter and left ventricular ejection fraction.The time to peak systolic velocity(Ts)of twelve segments was measured under the TSI Model.These segments included left ventricular lateral wall,posterior septum,anterior septum,posterior wall,anterior wall,inferior wall.The index of TSI was calculated automatically by the machines and the results would be displayed by the colorful “bull's eye” map.The TSI index included the septal lat delay,septal post delay,basal max delay,basal stdev,all seg max delay and all segments stdev.All of the operations are done by the same person.All of the data were measured three times and get the average value.Results:1 The comparison of basic parameters and echocardiography parameters among T2DM1,T2DM2 and control group were no statistical difference(P>0.05).2 In the NC group altogether 360 segments were tested and the TSI image of 354 segments were green and there were only 6 slightly delayed segments which were yellow and no moderately and severely delayed segments which were red.In T2DM1 group altogether 360 myocardial segments were tested while 201 segments were green.There were 159 slightly delayed segments which were yellow and no moderately and severely delayed segments which were red.The dyssynchrony segments were often located in lateral wall,posterior wall,then the inferior wall,anterior wall,posterior septum and anterior septum.In T2DM2 group altogether 360 segments were tested while 124 segments were green.There were 220 slightly delayed segments which were yellow and 16 moderately and severely delayed segments which were red.The dyssynchrony segments were often located in lateral wall,posterior wall,then the inferior wall,anterior wall,anterior septum and posterior septum.3 In case groups,the Ts of the same segments in same wall were remarkably prolonged than that of the NC group,the difference was striking(P<0.05).In T2DM2 group,the Ts of the same segments in same wall were remarkably prolonged than that of theT2DM1 group,the difference was striking(P<0.05).In NC group,there were no significant differences among the Ts of the same segment of different walls(P>0.05).But in case groups,there were remarkable differences among the Ts of the same segment of different walls(P<0.05).The Ts of both NC group and case groups were prolonged from the basal segment to the middle segment(P>0.05).4 The index of TSI in T2DM1,T2DM2 group was prolonged than that in NC group,the differences was statistically significant(P<0.05).The index of TSI in T2DM2 group was prolonged than that in T2DM1 group,the differences was statistically significant except septal post delay(P<0.05).5 The incidence of the left ventricular asynchrony in T2DM1 and T2DM2 group were higher than that in NC group,the difference had statistical significance(P<0.02).There was no significant difference in the incidence of left ventricular asynchrony between T2DM1 and T2DM2 group.(P>0.02).Conclusion:1 Both of the patients with type 2 diabetes mellitus and the patients with diabetic microangiopathy have left ventricular systolic asynchrony.And with the development of diabetic microangiopathy,the left ventricular systolic asynchrony is more obvious.2 There are no difference in the incidence of left ventricular systolic asynchrony between simple type 2 diabetic patients and the patients with diabetic microangiopathy.3 Abnormal regional myocardial movement can be sensitively evaluated by TSI.The technique not only directly displays the characters of time retardation of ventricular wall motion according to color changes but also provides quantitative analysis of time parameters of wall motion. |
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