Abstract
BackgroundA noninvasive left ventricular (LV) pressure-strain loop (PSL) provides a new method to quantify myocardial work (MW) by combining global longitudinal strain (GLS) and LV pressure, which exerts potential advantages over traditional GLS. We studied the LV PSL and MW in patients with type 2 diabetes mellitus (T2DM).MethodsThis cross-sectional study included 201 subjects (54 healthy controls and 147 T2DM patients) who underwent complete two-dimensional echocardiography (2DE), including 2D speckle-tracking echocardiography (STE), as well as brachial artery pulse pressure measurement. The PSL was used to determine the global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) of all study participants. The association between T2DM and LV function was evaluated according to these MW indices.ResultsThe GLS was significantly lower in the T2DM group than in the control group (P < 0.001), indicating that the LV myocardium had been damaged, although the LV ejection fraction (LVEF) was still normal. The GWI and GWE were decreased (P = 0.022) and the GWW was increased (P < 0.001) in diabetic patients compared with controls, but the GCW was comparable in the two groups (P = 0.160). In all diabetic patients, age, body mass index, systolic blood pressure, smoking history, and LVEF were correlated with GWI, GWW and GWE.ConclusionsThe use of LV PSL is a novel noninvasive technique that could help to depict the relationship between LV myocardial damage and MW in patients with T2DM.
Highlights
A noninvasive left ventricular (LV) pressure-strain loop (PSL) provides a new method to quantify myocardial work (MW) by combining global longitudinal strain (GLS) and LV pressure, which exerts potential advantages over traditional GLS
There was no significant difference in age or sex between the two groups, but there was a significant difference in body mass index (BMI), smoking history, systolic blood pressure (BP) (SBP) and diastolic BP (DBP) (P < 0.05)
There was no significant difference in the global constructive work (GCW) between the control and type 2 diabetes mellitus (T2DM) groups (1998. 76 0 ± 362.53 vs. 2075.13 ± 296.14 mmHg%, P = 0.160), and the global wasted work (GWW) was significantly greater in the T2DM group than in the control group (140 ± 87.63 mmHg% [IQR: 126.67– 155.24 mmHg%] vs. 69.22 ± 31.49 mmHg% [IQR: 60.63–77.82 mmHg%]; P < 0.001)
Summary
A noninvasive left ventricular (LV) pressure-strain loop (PSL) provides a new method to quantify myocardial work (MW) by combining global longitudinal strain (GLS) and LV pressure, which exerts potential advantages over traditional GLS. We studied the LV PSL and MW in patients with type 2 diabetes mellitus (T2DM). Type 2 diabetes mellitus (T2DM) is a global epidemic. The global prevalence of diabetes in 2019 was estimated to be 9.3% (463 million) and is expected to increase to 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045. T2DM accounts for approximately 90% of the total, Studies have shown that diabetes can lead to the development of structural heart disease and heart failure (HF) through systemic, myocardial and cellular mechanisms [3]. A review of recent studies has detailed the underlying mechanisms of diabetes-related HF [4], emphasizing that hyperglycemia and hyperinsulinemia accelerate atherosclerosis through vascular smooth muscle cell (VSMC) proliferation and inflammation. Diabetes is associated with atherogenic dyslipidemia, in which low-density
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