Value of peak strain dispersion in discovering left ventricular dysfunction in diabetes mellitus

Abstract

Cardiovascular disease is one of the main causes of death in diabetes mellitus (DM) patients. The aim of the current study was to explore the value of peak strain dispersion (PSD) for discovering early-stage left ventricular (LV) dysfunction in type 2 diabetes mellitus (T2DM) patients. One hundred and one T2DM patients and sixty healthy subjects were selected for this study. T2DM patients were further divided into controlled blood glucose (HbA1c < 7%, n = 46) and uncontrolled blood glucose (HbA1c ≥ 7%, n = 55) subgroups. All participants underwent conventional echocardiography and two-dimensional speckle-tracking echocardiography. Our results showed that an obvious difference was not observed in global longitudinal strain (GLS) between the controlled blood glucose group and the control group (- 20.34% vs - 21.22%, P = 0.068). Compared with the healthy controls, the uncontrolled blood glucose group showed an impaired GLS (- 18.62% vs - 21.22%, P < 0.001). Nevertheless, PSD was appreciably increased in the controlled blood glucose group (36.02 ms vs 32.48 ms, P = 0.01) and uncontrolled blood glucose group (57.51 ms vs 32.48 ms, P < 0.001). Multivariate linear regression analysis showed that HbA1c was closely related to PSD lesion in the LV in the T2DM group (β = 0.520, P < 0.001). PSD plays an important role in evaluating the coordination and synchronization of myocardial movement and provides a more accurate and sensitive index assessment of early LV systolic function in T2DM patients. In addition, HbA1c levels were related to LV dysfunction.

Figure 1

Bullseye plots of time to peak longitudinal strain are shown in two T2DM patients using EchoPAC workstation 2DSTE analysis. The endocardium of the LV was tracked point by point in the apical four-chamber, apical three-chamber and apical two-chamber views. After 17 segments of the LV were successfully tracked, GLS and LV PSD were automatically abtained. A patient with controlled blood glucose (HbA1c < 7%) displayed an LV GLS of 20.4% (absolute value) and LV PSD of 37 ms (A). More pronounced LV GLS of 12.3% (absolute value) and LV PSD of 72 ms were observed in a DM patient with uncontrolled blood glucose (HbA1c ≥ 7%) (B). AVC aortic valve closure, ANT anterior, SEPT septal, LAT lateral, POST posterior, INF inferior.

Figure 2

Impairment of GLS (A) and PSD (B) parameters in the LV in T2DM patients.

Figure 3

Reproducibility within intra-observer and inter-observer measurements for the GLS and PSD parameters.