Study Of Left Ventricular Function And Related Factors In Patients With Type 2 Diabetes Mellitus By Multiparameter Echocardiography

Background:Diabetic cardiomyopathy is defined as cardiomyopathy caused by diabetic factors and the exclusion of other causes of cardiomyopathy,such as ischemic heart disease,hypertension and so on.However,diabetic patients themselves are associated with a variety of cardiovascular risk factors,such as hypertension,hyperlipidemia,smoking,obesity,diabetes and these risk factors are mixed,eventually leading to diabetic heart damage,diabetes duration is long,different stages of heart structure and function changes,in the subclinical phase of the heart The structure of the viscera is normal or myocardial hypertrophy,and the function of the heart is manifested in the early stage of diastolic dysfunction,and in the late stage of clinical symptoms or symptoms may be manifested in obvious changes in structure and function.Conventional electrocardiogram and conventional echocardiography are common methods to evaluate cardiac structure and function in clinic.But these methods are not sensitive to the detection results of early myocardial damage in diabetic patients.What are the ultrasonic characteristics of diabetic cardiomyopathy?How to use a variety of ultrasonic techniques to evaluate diabetic patients early and accurately?Cardiac function,through a sensitive and quantitative technology to diagnose whether there is abnormal cardiac function is very important,for the early diagnosis and intervention of cardiovascular damage in diabetic patients,more and more clinical attention.We are currently using conventional echocardiography to assess cardiac diastolic and systolic functions,such as early and late diastolic velocities of mitral valves,left ventricular ejection fraction,and so on.These parameters are used to assess cardiac structure and hemodynamics.Significant functional changes are helpful in assessing cardiac function,but there are limitations for early functional tests,which do not provide a good early and accurate assessment of cardiac function.With the development of ultrasound technology,especially the development of noninvasive biomechanics,biomechanics refers to the application of mechanical principles and methods to study the physical properties of various organs and tissues.Myocardial biomechanics is a sensitive indicator of myocardial function by measuring the force produced during the process of myocardial contraction and diastole.Such as strain,strain rate and so on.The original method used to measure strain is based on tissue Doppler.The derivative of this method is tissue Doppler imaging(TDI),which is based on the same principle as pulse and color Doppler echocardiography.Wall filters are used to distinguish signals of moving tissue and blood flow.They are high-pass filters for imaging blood flow velocity or low-pass filters for displaying tissue velocity.The left ventricular wall function was evaluated by mitral orifice flow spectra and velocity of mitral annulus,and then the heart function was evaluated objectively,sensitively and accurately.TDI is angle-dependent,susceptible to the movement of the heart as a whole and adjacent tissue movement interference and other adverse factors,for the movement of the apex can not be displayed and so on.With the development of ultrasound technology,especially the development of noninvasive biomechanics,biomechanics refers to the application of mechanical principles and methods to study the physical properties of various organs and tissues.Myocardial biomechanics is a sensitive indicator of myocardial function by measuring the force produced during the process of myocardial contraction and diastole.Such as strain,strain rate and so on.The original method used to measure strain is based on tissue Doppler.The derivative of this method is tissue Doppler imaging(TDI),which is based on the same principle as pulse and color Doppler echocardiography.Wall filters are used to distinguish signals of moving tissue and blood flow.They are high-pass filters for imaging blood flow velocity or low-pass filters for displaying tissue velocity.The left ventricular wall function was evaluated by mitral orifice flow spectra and velocity of mitral annulus,and then the heart function was evaluated objectively,sensitively and accurately.TDI is angle-dependent,susceptible to the movement of the heart as a whole and adjacent tissue movement interference and other adverse factors,for the movement of the apex can not be displayed and so on.Objective:To investigate the value of conventional echocardiography combined with tissue Doppler echocardiography and speckle tracking technique in assessing left ventricular function in patients with diabetes mellitus.Methods:1.Methods 48 patients with type 2 diabetes were selected from the Jiaxing Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medicine University from 1 to July 2018.The diagnosis is in line with the diagnostic criteria for prevention and treatment of type 2 diabetes in China(2013 Edition).Exclusive criteria:No coronary atherosclerotic heart disease,severe mitral regurgitation,aortic stenosis,severe arrhythmia and other cardiomyopathy were confirmed by clinical history,laboratory and electrocardiogram.48 patients with type 2 diabetes mellitus,24 males and 24 females,aged 35-69 years,with an average age of(57.70±12.27)years.Thirty-six healthy volunteers from Jiaxing Hospital of Traditional Chinese Medicine affiliated to Zhejiang University of Traditional Chinese Medicine were enrolled in the control group.Among them,24 were males and 12 were females,aged from 33 to 65 years,with an average age of(49.94±15.89)years.Congenital heart disease,diabetes mellitus,coronary atherosclerotic heart disease,valvular disease,severe arrhythmia and other cardiomyopathy were excluded by clinical data and laboratory tests.2.Using GE Vivid E9 ultrasonic diagnostic instrument,M5S probe,frequency 3.5 MHz,frame frequency 70-80 frames/s,all subjects were routinely taken left lateral decubitus position,synchronous recording of ECG,conventional echocardiography and tissue Doppler to obtain left atrial diameter(LA),left ventricular mass index(LVMI),relative wall thickness(RWT),left ventricle.End-diastolic internal diameter(LVDd),left ventricular end-systolic internal diameter(LVDs),end-diastolic interventricular septum(IVSTd),left ventricular posterior wall thickness(PWTd),left ventricular ejection fraction(LVEF),early diastolic velocity(E),late diastolic velocity(A),early and late diastolic blood The ratio of flow velocity(E/A),tissue Doppler mitral annulus lateral wall velocity(e),mitral orifice E wave velocity(E/e)and tissue Doppler mitral annulus lateral wall velocity(E/e)were used to obtain satisfactory dynamic images of apical four-chamber,two-chamber and long-axis three-chamber sections of the left ventricle,and the aortic blood flow spectra obtained by five-chamber view of the left ventricular apex.The state image is saved.The local strain and strain curves and color strain displacement maps of each section were obtained.The 17-stage spot bovine eye maps were synthesized.The left ventricular wall 2DLSe values of 17 segments and the end-systolic two-dimensional longitudinal strain(end-systolic two-dim)of the whole left ventricle were obtained.The values of ensional global longitudinal strain,2DGLSe,and the average values of 2DLSe in each segment were stored in computer for analysis.3.ROC curves were drawn to calculate the best cut-off value,sensitivity,specificity and area under the ROC curve(AUC)for predicting diabetic lesions with MO.4.To analyze the correlation between 2DGLSe and cardiovascular risk factors in diabetic patients.Results:1.General data comparison:There were no significant differences in age,sex,diastolic blood pressure,high density lipoprotein cholesterol and low density lipoprotein cholesterol between the two groups.There were significant differences in diabetes duration,body mass index,systolic blood pressure,smoking,triglyceride concentration,blood glucose,glycosylated hemoglobin concentration.2.Comparison of conventional echocardiography and left ventricular diastolic function between the two groups:There were no significant differences in LA LVEDd,LVEDs,IVSDd,LVPWTd,LVEF and A between the two groups,but there were significant differences in E,E/A and E/e.3.There was no significant difference in the basal segment of inferior septum,the basal segment of lateral wall,the basal segment of posterior wall and the middle segment of posterior wall between the healthy control group and the diabetic group.There were significant differences among the segmental,anterior,posterior,inferior,lateral,inferior,anterior,ventricular septum,inferior,lateral and apical segments.4.The best cut-off value of MO for predicting diabetic cardiomyopathy was ?15.4%,sensitivity 97.2%,specificity 75%,and AUC 0.78.5.The average longitudinal strain of left ventricle was negatively correlated with diabetic duration,systolic blood pressure,blood glucose and HbAlc concentration,and positively correlated with HDL.Conclusions:In this study,we evaluated the left ventricular function in diabetic patients by multiple ultrasound techniques.1.the change of cardiac structure in early diabetes is mainly caused by RWT.2.E,E/A ratio and E/e ratio can be used to assess diastolic function in diabetic patients.3.the left ventricular myocardial 2DLSe can detect myocardial ischemia more early than LVEF.4.Compared with the control group,there was no significant difference in the lower septum basal segment,lateral wall basal segment,posterior wall basal segment and posterior wall middle segment in the diabetic group.Compared with the control group,the basal segment of anterior wall,basal segment of anterior septum,basal segment of inferior wall,middle segment of anterior wall,middle segment of posterior septum,middle segment of inferior septum,middle segment of lateral wall,middle segment of inferior wall,apical segment of anterior wall,apical segment of ventricular septum,apical segment of inferior wall,apical segment of lateral wall,apical segment of apex of apex of ventricle were statistically significant.5.The best cut-off value of MO for predicting diabetic cardiomyopathy was-15.4%,sensitivity 97.2%,specificity 75%,and AUC 0.78.6.The average longitudinal strain of left ventricle was negatively correlated with diabetic duration,systolic blood pressure,blood glucose and HbAlc concentration,and positively correlated with HDL.7.Conventional echocardiography and biomechanical tissue Doppler imaging combined with speckle tracking technique can be used to assess the cardiac function of diabetic patients.More information can be obtained and the early,effective and quantitative assessment of diabetic myocardial damage,especially subclinical diastolic function and systolic function can be carried out.