Abstract
Objective
The research was aimed to evaluate the subclinical left ventricular (LV) myocardial systolic dysfunction in T2DM patients with or without hypertension (HT) by global and segmental myocardial work (MW).
Methods
A total of 120 T2DM patients (including 60 T2DM patients with HT) and 70 sex- and age- matched normal controls were included. The global and segmental variables of work index (WI), constrictive work (CW), waste work (WW), work efficiency (WE), and CW/WW were analysed by non-invasive pressure-strain loop. Receiver operating characteristic (ROC) analysis was performed for detection the subclinical LV systolic dysfunction in T2DM patients with and without HT.
Results
The global work index (GWI), global CW (GCW), global WE (GWE), and GCW/global WW (GWW) of T2DM and T2DM patients with HT were significantly lower than normal controls (p < 0.05). The WI, CW, WE, and CW/WW of the LV anterior wall in T2DM and T2DM patients with HT were significantly lower when compared with those of the normal controls (p < 0.05). ROC analysis showed that the value of area under the curve (AUC) in combined GWI, GCW, GWE, and GCW/GWW was significantly higher than the AUCs of the individual indices (p < 0.05).
Conclusions
MW can non-invasively and accurately evaluate subclinical global and segmental LV myocardial systolic dysfunction in T2DM patients with and without HT. Regulating total cholesterol levels and controlling blood pressure in T2DM patients with and without HT might reduce the impairment of LV myocardial systolic function.
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Introduction
With the growth of the population and increased longevity, non-infectious chronic diseases (NCDs) are still the main causes of poor health worldwide. In a report released by the World Health Organization in 2022 [1], as one of the most common NCDs, type 2 diabetes mellitus (T2DM) has shown an increasing trend in both incidence and mortality over the last 20 years. Cardiovascular complications are viewed as dangerous complications of T2DM culminating in death [2]. Although ischaemic events dominate cardiovascular complications, in the absence of myocardial ischaemia and conditions of hypertension, diabetic cardiomyopathy also carries an increased risk of progression to heart failure [3]. In previous studies in which left ventricular (LV) global longitudinal strain (GLS) was measured using speckle-tracking echocardiography (STE), patients with T2DM who developed myocardial dysfunction could be identified even when LV ejection fraction (LVEF) was preserved [4, 5]. The acquisition of LV global radial, circumferential, and longitudinal strain by cardiovascular magnetic resonance (CMR) tissue tracking also enables the evaluation of myocardial systolic function in T2DM patients [ MW can non-invasively evaluate subclinical global and segmental LV myocardial systolic dysfunction in T2DM patients with and without HT. TC and SBP were independent influencing factors for GCW in T2DM patients with and without HT. Regulating total cholesterol levels and controlling blood pressure in T2DM patients with and without HT might reduce the impairment of LV myocardial systolic function. There are still some limitations in the present study. First, patients with poor image quality due to obesity, smoking, etc., were excluded, so this exclusion criterion may be biased for different operators. Furthermore, the present study was a single-centre study, and multicentre large sample studies are needed to further provide reference value for this finding.Conclusion
Limitations
Availability of data and materials
The datasets used and analysed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- BMI:
-
Body mass index
- BSA:
-
Body surface area
- SBP:
-
Systolic blood pressure
- DBP:
-
Diastolic blood pressure
- HbA1c:
-
Glycosylated hemoglobin A1c
- TC:
-
Total cholesterol
- TG:
-
Triglyceride
- HDL-C:
-
High-density lipoprotein cholesterol
- LDL-C:
-
Low-density lipoprotein cholesterol
- FPG:
-
Fasting plasma glucose
- BUN:
-
Blood urea nitrogen
- SCR:
-
Serum creatinine
- LA:
-
Left atrial
- LAV:
-
Left atrial volume
- IVS:
-
Interventricular septum
- PW:
-
Posterior wall
- LV:
-
Left ventricular
- LVEDV:
-
LV end-diastolic volume
- LVESV:
-
LV end-systolic volume
- LVEF:
-
Left ventricular ejection fraction
- MAPSE:
-
Mitral annular plane systolic excursion
- LVGLS:
-
LV global longitudinal strain
- GWI:
-
Global myocardial work index
- GCW:
-
Global constructive work
- GWW:
-
Global waste work
- GWE:
-
Global work efficiency
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Acknowledgements
We would like to thank the department of Echocardiography, Cardiology and Endocrinology, the Affiliated Changzhou Second People's Hospital with Nan**g Medical University.
Funding
Changzhou Science and Technique Program (Grant No.: CJ20190098).
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GAL and JH designed the study and carried out the study, data collection and analysis, wrote the manuscript and JH revised the manuscript. GAL and XS collected the T2DM patients and normal controls. LF and JH performed the statistical analysis.
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The study complied with the Declaration of Helsinki and was reviewed and approved by the Human Subjects Committee of Changzhou Second People′s Hospital. Written informed consent was obtained from each couple enrolled in the study.
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The authors declared no conflict of interest.
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Li, GA., Huang, J., Sheng, X. et al. Assessment of subclinical left ventricular myocardial systolic dysfunction in type 2 diabetes mellitus patients with or without hypertension by global and segmental myocardial work. Diabetol Metab Syndr 15, 200 (2023). https://doi.org/10.1186/s13098-023-01180-0
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DOI: https://doi.org/10.1186/s13098-023-01180-0