The Clinical Research On Left Atrial Function In Patients With Type 2 Diabetes Mellitus By Real-time Three-dimensional Echocardiography

Objective:To research left atrial function in type 2 diabetes mellitus(T2DM)patients with with or without hypertension(HT)by real-time three-dimensional echocardiography technique(RT-3DE).Methods:62 cases diagnosed patients with type 2 diabetes were divided into simple diabetes without hypertension group(group B)and diabetes with hypertension group(group C)according to the presence of blood pressure,and 30 cases of healthy controls were selected as normal control(group A).All subjects would be checked using conventional two-dimensional ultrasonic technique,M type ultrasonic technique,pulse doppler and tissue doppler ultrasonic technique and real-time three-dimensional echocardiography technique(RT-3DE): left ventricular ejection fraction(LVEF)were measured under the mode of conventional two-dimensional ultrasound in every group;the left atrial diameter(LAd),the thickness of interventricular septum(IVS),left ventricular posterior wall thickness(LVPW)and left ventricular end-diastolic diameter(LVEDD)were measured under the mode of M type ultrasonic technique;the transmitral early diastolic blood flow peak velocity(VE)was measured with the pulse doppler mode;the early diastolic peak velocity of mitral annulus(Ve)was measured with the tissue doppler mode,and E/e ratio was calculated.Left atrial maximum volume(LAVmax),left atrial before contraction volume(LAVpreA)and left atrial minimum volume(LAVmin)were detected by RT-3DE.IV T hrough the standardization of surface area,we would receive the left atrial maximum volume index(LAVImax),the left atrial before contraction volume(LAVIpreA)and left atrial minimum volume index(LAVImin).Calculating the left atrial total emptying fraction(LATEF),left atrial passive emptying fraction(LAPEF)and left atrial active emptying fraction(LAAEF)finally.The correlation analysis between the left atrial volume parameters obtained by using RT-3DE and the E/e ratio would be done in two T2 DM groups.Results:1.The comparison of parameters obtained by the conventional two-dimensional and M type ultrasonic technique: the difference of LVEF was not statistically significant among the groups(P>0.05).LAd,IVS,LVPW,LVEDD: they were significantly higher in diabetes with hypertension group(group C)than those in other two groups(P < 0.05 or P< 0.001).2.The comparison of parameters detected by the pulse doppler and tissue doppler technique: the diabetes with hypertension group(group C)was significantly lower than the other two groups regarding Ve,and E/e ratio was significantly higher than it in other two groups,and the difference was statistically significant(P < 0.001).And VE in group C was only higher than it in the normal control group(group A)(P < 0.05).There was significant difference only regarding E/e ratio between group A and group B(P < 0.001).3.The comparison of parameters measured by RT-3DE: LAVImax,LAVIpreA,LAVImin were higher in T2 DM groups(group B,group C)than those in normal control group(group A),and they were higher in group C than those in group B,and the difference was statistically significant(P < 0.05 or P < 0.01 or P < 0.001).Regarding LATEF,LAPEF: they were lower in group B and group C than those in group A,they were lower in group C than those in group B,and the difference was statistically significant(P < 0.05 or P < 0.01 or P < 0.001).There was no statistical difference among groups regarding LAAEF(P > 0.05).4.Correlation analysis: LAVImax,LAVIpreA,LAVImin and LAAEF werepositively correlated with E/e ratio in two T2 DM groups(group B,group C)(P<0.01 or P<0.001),LATEF and LAPEF were also negatively correlated with E/e ratio(P<0.001).Conclusion:The left atrial function of pure T2 DM patients has changed,and if accompanied with hypertension,the abnormal change of left atrial function is more significant.The left ventricular diastolic dysfunction may exist in patients with normal left ventricular systolic function measured by conventional ultrasonic technique.By measuring the left atrial volume parameters can not only discover the abnormal change of left atrial function,but also can evaluate the left ventricular diastolic function indirectly,and can provide more evidence for evaluation of cardiac damage in T2 DM patients.