Study On The Longitudinal Function Of The Left Ventricle In Diabetic Patients With Microvascular Disease By Stratified Strain Technique

Objective:To analyze the longitudinal peak strain of left ventricular subendocardial myocardium,middle myocardium and subepicardial myocardium in patients with diabetes mellitus complicated with microangiopathy by speckle tracking stratified strain technique,so as to evaluate the myocardial function in early stage.Methods:A collection of patients with type 2 diabetes who came to the Second Hospital of Shanxi Medical University from April 2020 to January 2021.A total of 40 cases were collected,including 26 males and 14 females.The patients were classified according to whether they had microvascular disease.As follows: 20 cases of diabetes group(group B),20 cases of diabetes combined with microvascular disease group(group C),and 20 cases of healthy volunteers were collected as control group(group A),and other serious diseases related to the heart were excluded.All subjects underwent conventional echocardiographic examination,conventional two-dimensional ultrasound measurement of the left atrium anterior and posterior diameter(LAD),end-diastolic ventricular septal thickness(IVS)and left ventricular posterior wall thickness(LVPW),left ventricle End-diastolic diameter and end-systolic diameter(LVIDd,LVIDs),left ventricular end-diastolic diameter and end-systolic volume(End-diastolic volume,End-systolic volume,EDV,ESV),the ratio of peak flow velocity(E/A)between early and late diastole of mitral valve orifice,then the Simpson method was used to obtain the left ventricular ejection fraction(Left ventricular ejection fraction,LVEF),by apical four-chamber and two-chamber biplane mapping,and then the two-dimensional echocardiographic images of at least three cardiac cycles were collected and stored,and the apical two-chamber,three-chamber and four-chamber images were obtained.The collected two-dimensional dynamic images were imported into the offline analysis software Qlab13.0,and the left ventricular myocardial segments were semi-automatically analyzed according to the method of 17 segments of left ventricle.The global longitudinal strain(GLS)of the left ventricle during systole was obtained by recording the endocardium and epicardium.After that,the left ventricular three-layer myocardium was recorded by stratified strain mapping,and the endocardial longitudinal peak strain(Longitudinal peak strain in endocardium,LPSendo),middle myocardial peak longitudinal strain(Longitudinal peak strain in mid-cardium,LPSmid)and epicardial peak longitudinal strain(Longitudinal peak strain in epi-cardium,LPSepi)were obtained.Then the transmural strain pressure difference of left ventricle was obtained from the peak longitudinal strain difference between subendocardial and subepicardial myocardium.Results:1.Comparison of general data parameters: there was no significant difference in age,blood pressure,heart rate,height and body mass index among group A,group B and group C(P > 0.05),but the course of disease in group C was longer than that in group B(P < 0.05).2.Comparison of routine ultrasound parameters: there was no significant difference in LAD,IVS,LVPW,LVIDd,LVIDs and LVEF among group A,group B and group C,but there was no significant difference between group B and group C(P > 0.05).3.Comparison of strain parameters:(1).Compared with group A,the longitudinal peak strain(GLS)of left ventricle in group C was significantly lower than that in group A,but there was no significant difference in GLS in group B,and the GLS in group C was significantly lower than that in group B.(2).Compared with group A,the LPSendo in group B was significantly lower than that in group A,but there was no significant difference in the LPSmid and LPSepi in group B(P > 0.05).LPSendo,LPSmid and LPSepi decreased in group C,and LPSendo,LPSmid and LPSepi in group C also decreased compared with group B(P < 0.05).(3).Compared with group A,left ventricular ΔLS in group B was statistically significant,but there was no significant difference in left ventricular Δ LS in group C,and the left ventricular ΔLS in group B was also lower than that in group C(P < 0.05).4.Correlation analysis showed that: GLS,LPSendo,LPSmid,LPSepi were negatively correlated with the course of the disease(r=-0.491,-0.546,-0.578 and-0.592,all P<0.001);there was no linear correlation between LS and the course of the disease(R=0.305,P>0.05).Conclusion:1.The left ventricular diastolic function of patients with diabetes mellitus complicated with microangiopathy is damaged.2.Compared with the total longitudinal peak strain parameter of the left ventricle,with the application of stratified strain technique,endocardial myocardial damage in patients with diabetes can be found in the early stage of the disease,and clinical intervention can be carried out to prevent further damage of myocardial function.3.The transmural pressure difference of the left ventricle cannot be used alone as an indicator to reflect whether the left ventricular myocardial systolic function is abnormal.