Evaluation Of Left Ventricular Systolic Function In Patients With Type 2 Diabetes By Using Layer-specific Strain

ObjectiveTo evaluate the early changes of left ventricular structure,myocardial contractile strain,synchronization,and myocardial work parameters in patients with type 2 diabetes mellitus(T2DM)by using layer-specific strain,and to explore the clinical application value of layer-specific strain technique in assessing left ventricular systolic function in patients with T2DM.MethodsFrom October 2018 to April 2019,45 diabetic patients diagnosed by our endocrinology department(Zhengzhou University People's Hospital)were selected,including 25 males and 20 females,aged 38 to 62 years.All patients underwent myocardial perfusion imaging.According to MPI results,45 patients with diabetes were divided into diabetes group A(24 patients with diabetes complicated with coronary microcirculation disorder)and diabetes group B(21 patients with diabetes alone)..Meanwhile,30 healthy volunteers with matched gender and age were used as the control group.Conventional echocardiography was used to measure left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic diameter(LVDs),left ventricular ejection fraction(LVEF),interventricular septal thickness(IVST),and left ventricular posterior wall thickness(LVPW).The two-dimensional dynamic images of the left ventricular apex two-chamber view(2AC),the left ventricular apex three-chamber view(LAX)and the left ventricular apex four-chamber view(4AC)of all subjects were collected for three consecutive cardiac cycles.a At the same time,brachial artery blood pressure data were recorded when the subjects collected images,and blood pressure fluctuations in T2DM patients were followed up in the past two weeks.By EchoPAC quantitative analysis software,overall inner longitudinal strain(GLSendo),overall middle longitudinal strain(GLSmid),overall outer longitudinal strain(GLSepi)and peak strain dispersion(PSD)of left ventricular myocardium were calculated automatically.The differences of strain and peak strain dispersion of the three myocardial layers in three groups were analyzed.From 45 T2DM patients,30 patients with brachial artery blood pressure with a relatively small fluctuation range in the near future(all within 10mmHg)were collected as the diabetes group,and 20 healthy volunteers with the same gender and age were selected as the control group.The brachial arterial blood pressure(systolic/diastolic)of the subjects was input on the basis of analyzing the left ventricular myocardial strain parameters of the subjects,and the parameters such as the left ventricular long axis global work index(GWI),global constructive work(GCW),global wasted work(GWW)and global work efficiency(GME)were obtained.The difference of myocardial work between diabetic patients and control group was analyzed.Result1.Overall stratified strain parameters:GLSendo,GLSmid and GLSepi of left ventricular myocardium were all from the normal control group>diabetes B group>diabetes A group,and the differences between any two groups were statistically significant(P<0.05).2.Synchronous parameters:all PSD were healthy control group<diabetes group B<diabetes group A,and the differences between any two groups were statistically significant(P<0.05).3.Cardiac work parameters:the measured values of GWI,GCW and GME in the diabetes group were lower than those in the healthy control group,with statistically significant differences(P<0.05).GWW in the diabetes group was higher than that in the healthy control group,and the difference was statistically significant(P<0.05).Conclusion1.Patients with type 2 diabetes,who have normal left ventricular ejection fraction and coronary angiography showed without stenosis or stenosis rate?30%,thave impaired left ventricular myocardial contractile function and systolic synchronization.2.Myocardial systolic function was significantly reduced in patients with type 2 diabetes with coronary microcirculation disturbance.3.The PSD is sensitive to changes in left ventricular systolic synchrony.4.Layered strain imaging technology can non-invasively,conveniently and sensitively quantitatively analyze left ventricular function and provides a basis for clinical diagnosis of diabetic cardiomyopathy.5.Myocardial function is impaired in patients with T2DM due-to chronic hyperglycemia and insulin resistance.6.Patients with T2DM who retained ejection fraction and had normal ventricular wall movement had impaired myocardial deformability and systolic synchrony.7.The left ventricular pressure-strain loop eliminates the effect of post-load on myocardial strain and is a new and reliable non-invasive method for the quantitative analysis of myocardial work parameters.8.GWE may be a new parameter for evaluating the synchronicity of cardiac contractions.