| Objective:The three-dimensional speckle tracking imaging(3D-STI)was applied to evaluate the changes of left ventricular systolic function in patients with type 2diabetes mellitus(T2DM)and patients with T2 DM plus diabetic kidney disease(DKD),and to investigate the effect of DKD on left ventricular systolic function,so as to provide a reference basis for early clinical diagnosis and early intervention.Methods:Fifty patients with T2 DM who were hospitalized in the Department of Endocrinology and the Department of Nephrology of our hospital from December2019 to December 2020 were selected and divided into 24 cases in the T2 DM group and 26 cases in the T2 DM plus DKD group,and another 27 age-and gender-matched healthy volunteers were selected as the normal control group during the same period.Three-dimensional whole-volume images of the left ventricle were acquired from all subjects,which were imported into the Echo PAC workstation for offline analysis,and the 3D-STI was applied to calculate volumetric parameters such as left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),three-dimensional ejection fraction(3D-EF),and strain parameters such as global longitudinal strain(GLS),global radial strain(GRS),global circumferential strain(GCS),and global area strain(GAS),and compare the differences between the three groups.Results:Comparison of general clinical data: age,sex,heart rate,height,weight,body surface area,and body mass index were not statistically significant(P > 0.05);systolic blood pressure,diastolic blood pressure,and serum creatinine were higher in the DKD group compared with the other two groups(P < 0.05),and the estimated glomerular filtration rate was significantly reduced compared with the other two groups(P < 0.001),and the differences were statistically significant;fasting plasma glucose and triglycerides were significantly higher in the DKD group and The fasting plasma glucose and triglycerides in the DM group were significantly higher than those in the control group(P < 0.001),and the differences were statistically significant.Comparison of 2D echocardiographic parameters: there were no statistical differences in LV end-diastolic internal diameter,LV end-systolic internal diameter,and LV ejection fraction among the three groups(P > 0.05);LV septal in diastolic and posterior wall dimension,peak A velocity,and E/Em were higher in the DKD and DM groups than in the control group(P < 0.05),and peak mitral annular Em velocity,E/A,and Em/Am were lower than in the control group(P < 0.05),and the above parameters were more significant in the DKD group,with statistically significant differences;the left ventricular mass index was higher in both the DKD and DM groups than in the control group(P < 0.05),and the anterior-posterior diameter of left atrial and relative ventricular wall thickness were higher in the DKD group than in the other two groups(P < 0.05),with statistically significant differences.Comparison of 3D-STI parameters: The differences of LVEDV and LVESV among the three groups were not statistically significant(P>0.05).GLS,GRS,GCS,and GAS were significantly reduced in the DKD and DM groups compared with the normal control group,and the differences were statistically significant(P<0.05);3D-EF was reduced in the DKD group compared with the normal control group,and the differences were statistically significant(P<0.05);In the DKD group,GLS,GRS and GAS were significantly lower than those in the DM group,and the difference was statistically significant(P < 0.05),while the difference in GCS was not statistically significant(P > 0.05).Conclusion:1.Relative left ventricular wall thickening and altered left ventricular diastolic function may be present early in patients with T2 DM,whereas further left ventricular wall thickening and impaired left ventricular diastolic function are present in patients with T2 DM plus DKD.2.There may be multiple early decreases in the left ventricular global strain parameters in T2 DM.3D-STI enables early detection of subclinical alterations in left ventricular systolic function in T2DM;When T2 DM patients plus DKD,even if the left ventricular ejection fraction is normal,the left ventricular global strain parameter is still further reduced,and DKD will aggravate the impaired left ventricular systolic function.3D-STI can detect the impaired left ventricular systolic function more sensitively and accurately in T2 DM plus DKD through quantitative analysis. |
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