Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jun 15, 2024; 15(6): 1272-1279
Published online Jun 15, 2024. doi: 10.4239/wjd.v15.i6.1272
Subclinical impairment of left ventricular myocardium function in type 2 diabetes mellitus patients with or without hypertension
Zeng-Guang Chen, Guang-An Li, Jun Huang, Li Fan
Zeng-Guang Chen, Department of Cardiology, The Affiliated Changzhou Second People’s Hospital with Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
Guang-An Li, Jun Huang, Li Fan, Department of Echocardiography, The Affiliated Changzhou Second People’s Hospital with Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
Co-first authors: Zeng-Guang Chen and Guang-An Li.
Author contributions: Chen ZG, Li GA, and Huang J designed the study and carried out the study, data collection, and analysis; Chen ZG and Li GA wrote the manuscript; Huang J revised the manuscript, and collected the type 2 diabetes mellitus patients and healthy subjects; Fan L performed the statistical analysis.
Supported by the Science and Technology Project of Changzhou Health Commission, No. ZD202342.
Institutional review board statement: This research was reviewed and approved by the Human Research and Ethics Committee of the Affiliated Changzhou Second People’s Hospital of Nanjing Medical University [Approval No. (2016)YLJSE009].
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data collected during the study are available from the Corresponding author by request: Huang J, E-mail: 305669112@qq.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Huang, MD, PhD, Chief Doctor, Postdoc, Teacher, Department of Echocardiography, The Affiliated Changzhou Second People’s Hospital with Nanjing Medical University, No. 68 Gelu Road, Changzhou 213000, Jiangsu Province, China. 305669112@qq.com
Received: December 26, 2023
Revised: March 6, 2024
Accepted: April 23, 2024
Published online: June 15, 2024
Abstract
BACKGROUND

Cardiovascular disease has been the leading cause of morbidity and mortality for type 2 diabetes mellitus (T2DM) patients over the last decade.

AIM

To determine whether layer-specific global longitudinal strain (GLS) combined with peak strain dispersion (PSD) can be used to assess left ventricle (LV) myocardium systolic dysfunction in T2DM patients or without hypertension (HP).

METHODS

We enrolled 97 T2DM patients, 70 T2DM + HP patients and 101 healthy subjects. Layer-specific GLS and PSD were calculated by EchoPAC software in apical three-, four- and two-chamber views. GLS of the epimyocardial, middle-layer and endomyocardial (GLSepi, GLSmid, and GLSendo) were measured and recorded. Receiver operating characteristic analysis was performed to detect LV myocardium systolic dysfunction in T2DM patients.

RESULTS

There were significant differences in GLSepi, GLSmid, GLSendo, and PSD between healthy subjects, T2DM patients and T2DM patients with HP (P < 0.001). Trend tests yielded the ranking of healthy subjects > T2DM patients > T2DM with HP patients in the absolute values of GLSepi, GLSmid and GLSendo (P < 0.001), while PSD was ranked healthy subjects < T2DM < T2DM with HP (P < 0.001). Layer-specific GLS and PSD had high diagnostic efficiency for detecting LV myocardium systolic dysfunction in T2DM patients, however, the area under the curve (AUC) for layer-specific GLS and PSD combined was significantly higher than the AUCs for the individual indices (P < 0.05).

CONCLUSION

Layer-specific GLS and PSD were associated with LV myocardium systolic dysfunction in T2DM patients, T2DM patients with HP. T2DM patients with HP have more severe LV myocardium systolic dysfunction than T2DM patients without HP and normal control patients. The combination of layer-specific GLS and PSD may provide additional prognostic information for T2DM patients with or without HP.

Keywords: Type 2 diabetes mellitus, Hypertension, Speckle tracking echocardiography, Global longitudinal strain, Peak strain dispersion

Core Tip: Left ventricle (LV) myocardium systolic dysfunction was found in type 2 diabetes mellitus (T2DM) patients, T2DM patients with hypertension (HP) by layer-specific global longitudinal strain (GLS) and peak strain dispersion (PSD). T2DM patients with HP have more serious LV myocardium systolic dysfunction than T2DM patients without HP and normal control patients. Combined layer-specific GLS and PSD may provide additional prognostic information for T2DM patients with or without HP.