Evaluation of left ventricular systolic function in type 2 diabetes mellitus patients with and without peripheral vascular disease

doi:10.4239/wjd.v15.i6.1280

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World Journal of Diabetes

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World J Diabetes. Jun 15, 2024; 15(6): 1280-1290
Published online Jun 15, 2024. doi: 10.4239/wjd.v15.i6.1280

Table 1 Clinical parameters of patients among normal controls, type 2 diabetes mellitus patients without peripheral vascular disease and type 2 diabetes mellitus patients with peripheral vascular disease

Clinical parameters	Normal controls (n = 63)	T2DM without PVD (n = 65)	T2DM with PVD (n = 57)	P value
Age, yr	53.29 ± 7.55	54.75 ± 7.72	56.73 ± 7.76	0.053
Male, n (%)	31 (49)	38 (58)	38 (67)	0.103
Height, cm	164.84 ± 7.07	165.83 ± 8.61	164.20 ± 6.98	0.492
Weight, kg	63.56 ± 10.09	68.95 ± 11.76^a	67.32 ± 11.35	0.021
BMI, kg/m²	23.33 ± 2.91	24.97 ± 3.12	24.89 ± 3.40^a	0.005
BSA, m²	1.67 ± 0.16	1.74 ± 0.19	1.71 ± 0.17	0.054
SBP, mmHg	77.90 ± 0.57	82.17 ± 10.81^a	80.18 ± 10.58	0.001
DBP, mmHg	123.38 ± 11.12	132.77 ± 16.29^a	130.70 ± 17.30^a	0.049
HR, bpm	66.95 ± 8.61	75.58 ± 9.91^a	74.80 ± 8.20^a	< 0.001
HbA1c, %	5.48 ± 0.35	9.47 ± 2.39^a	9.94 ± 2.39^a	< 0.001
TC, mmol/L	4.53 ± 0.85	4.36 ± 1.06	4.55 ± 1.03	0.550
TG, mmol/L	1.30 (0.89, 1.80)	1.52 (0.93, 2.43)	1.64 (1.01, 2.07)	0.073
HDL-C, mmol/L	1.25 ± 0.33	1.08 ± 0.29	1.08 ± 0.34	0.013
LDL-C, mmol/L	2.65 ± 0.70	2.58 ± 0.84	2.70 ± 0.83	0.729
LPA, g/L	0.17 (0.09, 0.29)	0.12 (0.06, 0.32)	0.16 (0.09, 0.25)	0.772
FPG, mmol/L	4.99 (4.57, 5.28)	10.02 (7.44, 13.64)^a	10.25 (8.29, 14.07)^a	< 0.001
BUN, mmol/L	4.90 (3.60, 6.40)	5.65 (4.70, 6.58)	6.00 (4.70, 7.40)^a	0.015
SCr, μmol/L	65.00 (56.00, 76.00)	61.00 (51.75, 81.95)	61.70 (52.20, 73.00)	0.772
Medication (%)
ACEI/ARB	-	13 (20)	12 (21)
Calcium channel blocker	-	10 (15)	20 (35)
β-blocker	-	1 (2)	2 (4)
SGLT-2 inhibitor	-	14 (22)	19 (33)
Metformin	-	36 (55)	36 (63)
Insulin	-	41 (63)	42 (74)

^aP < 0.05, indicates significantly different when type 2 diabetes mellitus (T2DM) patients without peripheral vascular disease (PVD) or T2DM patients with PVD compared with the normal controls.

T2DM: Type 2 diabetes mellitus; BMI: Body mass index; BSA: Body surface area; SBP: Systolic blood pressure; DBP: Diastolic blood pressure. HR: Heart rate; FPG: Fasting plasma glucose; HbA1c: Glycated haemoglobin; TC: Total cholesterol; TG: Triglyceride; HDL-C: High density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; LPA: Lipoprotein a; BUN: Blood urea nitrogen; SCr: Serum creatinine.

Table 2 Echocardiographic parameters among normal controls, type 2 diabetes mellitus patients without peripheral vascular disease and type 2 diabetes mellitus patients with peripheral vascular disease

Echocardiographic parameters	Normal controls (n = 63)	T2DM without PVD (n = 65)	T2DM with PVD (n = 57)	P value
LAd, mm	34.42 ± 2.76	35.47 ± 3.25	36.17 ± 3.82^a	0.015
IVSd, mm	9.39 ± 0.74	9.20 ± 0.97	9.27 ± 0.97	0.477
LVPWd, mm	9.05 ± 0.77	8.98 ± 0.99	9.13 ± 1.06	0.685
LVDd, mm	46.35 ± 2.97	45.42 ± 3.60	46.60 ± 3.24	0.110
LVEDV, mL	76.76 ± 14.89	74.02 ± 16.74	78.04 ± 15.98	0.358
LVESV, mL	26.75 ± 6.53	26.12 ± 7.13	26.63 ± 6.47	0.857
LVEF, %	65.19 ± 3.98	64.98 ± 3.39	65.81 ± 4.16	0.478
MAPSE, mm	14.44 ± 1.49	14.16 ± 1.85	13.23 ± 1.87^a^,^b	0.001
E, m/s	0.84 ± 0.13	0.75 ± 0.15^a	0.79 ± 0.13^a	0.001
A, m/s	0.70 ± 0.15	0.74 ± 0.18	0.81 ± 0.17^a^,^b	0.002
E/A	1.24 ± 0.28	1.08 ± 0.34^a	1.01 ± 0.27^a	< 0.001
e′, m/s	0.11 ± 0.02	0.09 ± 0.02^a	0.09 ± 0.02^a	< 0.001
E/e′	8.09 ± 1.54	8.66 ± 1.53	9.45 ± 1.92^a^,^b	< 0.001

^aP < 0.05, indicates significantly different when type 2 diabetes mellitus (T2DM) patients without peripheral vascular disease (PVD) or T2DM patients with PVD compared with the normal controls.

^bP < 0.05, indicates significantly different when T2DM patients with PVD compared with T2DM patients without PVD.

LAd: Left atrial diameter; IVSd: Interventricular septal wall thickness in end-diastolic period; LVPWd: Left ventricular posterior wall thickness in end-diastolic period; LVDd: Left ventricular diameter in end-diastolic period; LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume; LVEF: Left ventricular ejection fraction; MAPSE: Mitral annular plane systolic excursion; E: Peak velocity during early diastole of anterior mitral leaflet; A: Peak velocity during late diastole of anterior mitral leaflet; e′: Peak early diastolic annular velocities using TDI by averaging the values at the septum and lateral positions; PVD: Peripheral vascular disease; T2DM: Type 2 diabetes mellitus.

Table 3 Layer-specific global longitudinal strain and peak strain dispersion among normal controls, type 2 diabetes mellitus patients without peripheral vascular disease and type 2 diabetes mellitus patients with peripheral vascular disease

	Normal controls (n = 63)	T2DM without PVD (n = 65)	T2DM with PVD (n = 57)	P value	P trend
GLSepi, %	-18.65 ± 1.55	-17.37 ± 1.85^a	-16.92 ± 2.21^a	< 0.001	< 0.001
GLSmid, %	-21.57 ± 1.81	-19.98 ± 2.08^a	-19.47 ± 2.50^a	< 0.001	< 0.001
GLSendo, %	-25.03 ± 2.21	-23.12 ± 2.43^a	-22.72 ± 2.85^a	< 0.001	< 0.001
PSD, msec	30.63 ± 7.29	35.03 ± 10.81^a	39.37 ± 12.42^a^,^b	< 0.001	< 0.001

^aP < 0.05, indicates significantly different when type 2 diabetes mellitus (T2DM) patients without peripheral vascular disease (PVD) or T2DM patients with PVD compared with the normal controls.

^bP < 0.05, indicates significantly different when T2DM patients with PVD compared with T2DM patients without PVD.

GLS: Global longitudinal strain; GLSEpi: Global longitudinal strain of the epimyocardial; GLSMid: Global longitudinal strain of the middle myocardial; GLSEndo: Global longitudinal strain of the endomyocardial; PSD: Peak strain dispersion; T2DM: Type 2 diabetes mellitus; PVD: Peripheral vascular disease.

Table 4 Receiver operating characteristic curve analysis for the detection the left ventricular systolic function in type 2 diabetes mellitus patients with peripheral vascular disease

ROC	GLSepi	GLSmid	GLSendo	PSD	Combined
Sensitivity, %	50.88	56.14	66.16	73.68	75.44
Specificity, %	85.71	85.71	77.78	65.08	77.78
Youden index	0.3659	0.4185	0.4094	0.3876	0.5322
AUC (95%CI)	0.735 (0.647-0.811)	0.753 (0.666-0.827)	0.750 (0.663-0.825)	0.735 (0.646-0.811)	0.801 (0.719-0.869)
Associated criterion	-17.0	-19.8	-23.5	32	0.44
P value	0.064	0.127	0.103	0.050

P values mean combined evaluation compare with global longitudinal strain and peak strain dispersion. GLSEpi: Global longitudinal strain of the epimyocardial; GLSMid: Global longitudinal strain of the middle myocardial; GLSEndo: Global longitudinal strain of the endomyocardial; PSD: Peak strain dispersion; ROC: Receiver operating characteristic; AUC: Area under the curve.

Table 5 Correlation test in type 2 diabetes mellitus patients with peripheral vascular disease

Varibles	GLSepi		GLSmid		GLSendo		PSD
Varibles	r value	P value	r value	P value	r value	P value	r value	P value
BMI	0.089	0.510	0.093	0.491	-0.009	0.945	-0.017	0.900
HbA1c	-0.011	0.935	0.028	0.839	-0.019	0.887	-0.225	0.095
TC	0.190	0.158	0.179	0.182	0.040	0.767	0.293	0.027
TG	-0.126	0.349	-0.153	0.257	-0.148	0.271	0.017	0.889
HDL-C	-0.033	0.812	-0.029	0.834	-0.165	0.228	0.093	0.499
LDL-C	0.340	0.010	0.327	0.014	0.204	0.131	0.290	0.030
LPA	0.159	0.254	0.134	0.339	0.184	0.187	-0.103	0.465
BUN	0.293	0.033	0.248	0.074	0.149	0.287	0.292	0.034
SCR	0.301	0.027	0.264	0.053	0.166	0.231	0.205	0.137
LVEF	-0.434	0.001	-0.439	0.001	-0.447	< 0.001	-0.109	0.420
MAPSE	-0.248	0.063	-0.313	0.018	-0.260	0.051	-0.111	0.411

BMI: Body mass index; HbA1c: Glycated haemoglobin; TC: Total cholesterol; TG: Triglyceride; HDL-C: High density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; LPA: Lipoprotein a; BUN: Blood urea nitrogen; SCR: Serum creatinine; GLS: Global longitudinal strain; GLSEpi: Global longitudinal strain of the epimyocardial; GLSMid: Global longitudinal strain of the middle myocardial; GLSEndo: Global longitudinal strain of the endomyocardial; PSD: Peak strain dispersion; LVEF: Left ventricular ejection fraction; MAPSE: Mitral annular plane systolic excursion.

Table 6 Intraclass correlation coefficients for intra- and inter-observer variability for layer specific global longitudinal strain and peak strain dispersion

Variable	Inter-observer variability		Intra-observer variability
Variable	ICC	95%CI	ICC	95%CI
GLSendo	0.955	0.887-0.982	0.964	0.910-0.986
GLSmid	0.963	0.906-0.985	0.970	0.924-0.988
GLSepi	0.960	0.900-0.984	0.970	0.925-0.988
PSD	0.956	0.889-0.983	0.979	0.946-0.992

GLSEpi: Global longitudinal strain of the epimyocardial; GLSMid: Global longitudinal strain of the middle myocardial; GLSEndo: Global longitudinal strain of the endomyocardial; PSD: Peak strain dispersion; ICC: Intraclass correlation coefficient.

Citation: Li GA, Huang J, Fan L. Evaluation of left ventricular systolic function in type 2 diabetes mellitus patients with and without peripheral vascular disease. World J Diabetes 2024; 15(6): 1280-1290
URL: https://www.wjgnet.com/1948-9358/full/v15/i6/1280.htm
DOI: https://dx.doi.org/10.4239/wjd.v15.i6.1280