Impact of Glycemic Control on Left and Right Ventricular Myocardial Function in Type 2 Diabetic Patients

doi:10.7517/issn.1674-0475.230807

Abstract

Abstract: This study investigated on left and right ventricular myocardial strain in patients with type 2 diabetes mellitus (T2DM), and the relationship between left and right ventricular dysfunction. A total of 100 patients with T2DM and normal left ventricular ejection fraction (LVEF) were divided into HbA1c＜7% group (n=54) and HbA1c≥7% group (n=46) according to HbA1c level. Forty healthy adult volunteers were selected as the control group. The data of conventional echocardiography and left ventricular global longitudinal strain (LVGLS), right ventricular global longitudinal strain (RVGLS) and right ventricular free wall longitudinal strain (RVFWLS) data were measured. The differences were compared among the groups. Multivariable linear regression analysis was performed for the associated between HbA1c and biventricular myocardial strain, and the correlation 47between left and right ventricular myocardial strain. LVGLS and RVGLS decreased gradually from the control group, HbA1c＜7% group to HbA1c≥7% group (all P<0.05). Compared with the control group, RVFWLS was decreased in HbA1c＜7% group and HbA1c≥7% group (all P＜0.05). However, there was no significant difference between the latter two (P＞0.05). Multiple linear regression analysis showed that HbA1c was the independent determinants for LVGLS, RVGLS and RVFWLS in T2DM patients, and LVGLS was independently associated with RVGLS and RVFWLS. The left and right ventricular myocardial strain decreased, and there is association between them in T2DM patients with normal left ventricular ejection fraction. HbA1c is an independent determinant for left and right ventricular myocardial dysfunction, suggesting that hyperglycemia was independently associated with impaired of the biventricular myocardial at the same time, and suggests adverse interventricular interactions.

Key words: type 2 diabetes mellitus, glycemic control, left ventricle, right ventricle

LIANG Limei, HE Xin, ZHAO Shiguang, ZHANG Huixin, LIU Hongli. Impact of Glycemic Control on Left and Right Ventricular Myocardial Function in Type 2 Diabetic Patients[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2024, 42(1): 47-52.

References

[1] Haddad F, Doyle R, Murphy D J, et al. Right ventricular function in cardiovascular disease, part Ⅱ:Pathophysiology, clinical importance, and management of right ventricular failure[J]. Circulation, 2008, 117(13):1717-1731.
[2] Lejeune S, Roy C, Ciocea V, et al. Right Ventricular Global Longitudinal Strain and Outcomes in Heart Failure with Preserved Ejection Fraction[J]. Journal of the American Society of Echocardiography:Official Publication of the American Society of Echocardiography, 2020, 33(8):973-984e972.
[3] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版)[J].中华内分泌代谢杂志, 2021, 37(4):311-398.
[4] Mitchell C, Rahko P S, Blauwet L A, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults:Recommendations from the American society of echocardiography[J]. Journal of the American Society of Echocardiography Official Publication of the American Society of Echocardiography, 2019, 32(1):1-64.
[5] 中国医师协会超声医师分会心脏超声专业委员会.二维斑点追踪超声心动图心肌纵向应变规范化检查中国专家共识(2023版)[J].中华超声影像学杂志, 2023, 32(4):277-287.
[6] 陈艳艳,周洁,卢作维,等.糖尿病心肌病发病机制及治疗研究进展[J].解放军医学杂志, 2022, 48(8):957-964.
[7] Mochizuki Y, Tanaka H, Matsumoto K, et al. Impact of left ventricular longitudinal functional mechanics on the progression of diastolic function in diabetes mellitus[J]. The International Journal of Cardiovascular Imaging, 2017, 33(12):1905-1914.
[8] 周小玲,田新桥,胡路路,等.三维斑点追踪成像评价短期胰岛素泵治疗对2型糖尿病患者左心室收缩功能的改善作用[J].中华超声影像学杂志, 2016, 25(2):116-121.
[9] Li Y, Li X W, Zhang Y H, et al. Impact of glycemic control status on patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention[J]. BMC Cardiovascular Disorders, 2020, 20(1):1-8.
[10] 江茂宁,王小娟,孙有海,等.实时三维超声心动图及速度向量成像技术评价2型糖尿病患者右心室功能及同步性的研究[J].中国糖尿病杂志, 2022, 30(12):897-901.
[11] 何垚,于绍梅,肖为为,等. 2型糖尿病左心室射血分数保留患者左右心室心肌功能的相关性研究[J].中国超声医学杂志, 2023, 39(6):672-675.
[12] Todo S, Tanaka H, Yamauchi Y, et al. Association of left ventricular longitudinal myocardial function with subclinical right ventricular dysfunction in type 2 diabetes mellitus[J]. Cardiovascular Diabetology, 2021, 20(1):1-7.
[13] Dibble C T, Lima J A C, Bluemke D A, et al. Regional left ventricular systolic function and the right ventricle:The multi-ethnic study of atherosclerosis right ventricle study[J]. Chest, 2011, 140(2):310-316.
[14] 苟春丽,刘永铭,薛丽丽,等.射血分数保留或减低心力衰竭患者肺动脉压及右心结构变化的研究[J].中国循环杂志, 2020, 35(11):1108-1114.