Assessment Of Left Ventricular Function In Patients With Gestational Diabetes Disease Speckle Tracking Technology

Purpose: Speckle tracking imaging(STI)is a relatively new ultrasound technique that treats the myocardium as an innumerable spot,tracks the movement of these spots,and obtains torsional motion parameters of the ventricle.It is used quantitatively to study the entire heart.And local systolic and diastolic function is a hot topic in recent years.Gestational diabetes mellitus(GDM)is an abnormal glucose tolerance or episode of hyperglycemia that occurs during pregnancy and is a clinically common gestational disease.During pregnancy,as the gestational age increases,the maternal endocrine system changes accordingly,and then the cardiovascular system changes such as cardiac output and blood volume increase,affect the heart shape and function,and the incidence of acute cardiovascular disease also follows.Increase.Therefore,early detection of GDM on the early structural and functional changes of the heart and effective clinical intervention is extremely important.In this study,the left ventricular long-axis view longitudinal strain,the short-axis tangential radial strain,circumferential strain and torsional motion were monitored by speckle tracking technique to obtain the systolic peak strain and torsion-related parameters of gestational diabetes.The abnormal left ventricular systolic and diastolic function in GDM patients was used to investigate the effect of gestational diabetes on left ventricular systolic and diastolic function,providing a theoretical basis for the preliminary clinical assessment of left ventricular systolic and diastolic dysfunction.Methods: From October 2017 to February 2018,we selected the gestational diabetes group as the observation group and the normal pregnancy at the same time.<35-year-old pregnant women in the late pregnancy for the normal pregnancy group was set as a control group,the experimental subjects without organic diseases,such as: high blood pressure,congenital heart disease,anemia and so on.All patients underwent echocardiography,and various indexes for evaluation of left ventricular function were collected to compare the changes of each index between the two groups of pregnant women.All participants received signed informed consent.In resting state,dynamic two-dimensional echocardiography,diastolic mitral subvalvular Doppler spectrogram,and tissue Doppler mitral annular motion velocity spectrogram were collected and analyzed by workstation software.Summarized as follows: 1.Two-dimensional conventional echocardiographic data were measured by conventional echocardiography,and left ventricular ejection fraction(EF)% was measured by the biplanar Simpson method.2.Speckle tracking technique was used to obtain the systolic left ventricular strain peak value,calculate the average value of each direction and compare with the normal control group;to obtain the subendocardial,epicardial and overall strain peak,strain across the wall The parameters of the step difference are compared with the control group.3.Comparing the parameter values of Ptw-endo,Ptwepi,Prot,Prot-epi,Prot-endo,Ptw-mur,Ptw obtained through STI technology with the control group.4.Detection of sub-mitral subvalvular spectral Doppler based on two-dimensional ultrasound images to obtain E-peak,A-peak,through the tissue Doppler mitral annulus velocity spectrum acquisition isovolumic relaxation time(IVRT),early diastolic and late Peak speeds(E ?,A ?),etc.5.Use STI technology to obtain the values of the parameters related to cardiac torsion and untwisting motion: Ptw,PTU,PUV,TPTV,TPUV,Untw R,etc.Then statistically compare these parameters.Result: 1.Compared with the normal control group,the gestational diabetes observation group's longitudinal strain(LS)decreased(P<0.05);the radial strain(RS)and the circumferential strain(CS)had no statistics difference.Significance(P>0.05).2.The peak apical to longitudinal basal segments of systolic left ventricular apical longitudinal strain increased in both groups in a sequential manner,and the peak amplitude of longitudinal strain was higher in the subendocardial subepicardium than in the same horizontal plane,and the difference was statistically significant(P < 0.05).<0.05);Observation group longitudinal strain across the wall is less than the normal control group,the difference was statistically significant(P <0.05).3.Comparison of GRS between two groups: Papillary,mitral,and apical levels decreased;GRS-end>GRS-epi at the same level(P<0.05).The radial stress peak value of the observer was higher than that of the control group(P>0.05).There was no statistically significant difference between the two groups in radial strain across the wall(P>0.05).4.The circumferential strains of the two groups increased gradually from the mitral valve level to the apical level;the same aspect level was GCS-end> GCS-epi(P<0.05).The peak of circumferential strain of gestational diabetes patients was smaller than that of the control group,but there was no statistical significance(P>0.05).5.The same aspect level Ptw-endo >Ptw-epi,Prot-endo> Prot-epi(P<0.05).Comparing the gestational diabetes group with the normal group,the peak value of the apical and mitral valve rotation angles and the peak value of the LV rotation angles all increased(P<0.05).6.The observation group E ?/A ?,EE ? was lower than the normal control group and IVRT was prolonged(P<0.05).7.Compared with the normal control group,the observation group PUV,Ptw and Untw R all decreased,the TPUV increased,and the TPTV became shorter,the difference was statistically significant(P<0.05).conclusion: 1.The left ventricular longitudinal systolic function of gestational diabetes mellitus(GDM)is lower than that of the normal control group;the left ventricular radial systolic function,torsional and rotational motion compensation are higher than the normal control group,and the left ventricular circumferential systolic function does not change significantly;Left ventricular systolic function in patients with gestational diabetes who showed no significant abnormal left ventricular ejection fraction(EF)% had a slight degree of abnormality.2.Compared with the normal control group,the left ventricular subendocardial myocardium in the gestational diabetes group had higher longitudinal strain,radial strain,peak circumferential strain and peak rotation and torsion angle than the same sub-epicardium;The radial movement across the wall decreases compared with the normal control group.The cross-wall gradient of the circular motion does not change significantly;the gradient of the cross-wall angle decreases,suggesting that the cross-sectional gradient and the transhorizontal angle gradient can reflect the heart muscle of gestational diabetes patients.Abnormal changes in systolic function.3.Comparing with the normal control group,the maximal left ventricular torsional angle peak,torsion velocity peak time,peak rotation speed,derotation rate,and spin-up speed were prolonged in the gestational diabetes group,suggesting the application of speckle tracking imaging.Left ventricular unwinding parameters can be used to evaluate left ventricular diastolic function changes in the technique(STI).