Additive effect of aortic regurgitation degree on left ventricular strain in patients with type 2 diabetes mellitus evaluated via cardiac magnetic resonance tissue tracking

Abstract

Background: Type 2 diabetes mellitus causes left ventricular (LV) remodeling and increases the risk of aortic regurgitation (AR), which causes further heart damage. This study aimed to investigate whether AR aggravates LV deformation dysfunction and to identify independent factors affecting the global peak strain (PS) of LV remodeling in patients with type 2 diabetes mellitus (T2DM) who presented with AR and those without T2DM.

Methods: In total, 215 patients with T2DM and 83 age- and sex-matched healthy controls who underwent cardiac magnetic resonance examination were included. Based on the echocardiogram findings, T2DM patients with AR were divided into three groups (mild AR [n = 28], moderate AR [n = 21], and severe AR [n = 17]). LV function and global strain parameters were compared, and multivariate analysis was performed to identify the independent indicators of LV PS.

Results: The T2DM patients with AR had a lower LV global PS, peak systolic strain rate (PSSR), and peak diastolic strain rate (PDSR) in three directions than those without AR and non-T2DM controls. Patients without AR had a lower PS (radial and longitudinal) and PDSR in three directions and higher PSSR (radial and longitudinal) than healthy controls. Further, regurgitation degree was an independent factor of LV global radial, circumferential, and longitudinal PS.

Conclusion: AR may aggravate LV stiffness in patients with T2DM, resulting in lower LV strain and function. Regurgitation degree and sex were independently correlated with LV global PS in patients with T2DM and AR.

Keywords: Aortic regurgitation; Left ventricle; Magnetic resonance imaging; Strain; Type 2 diabetes mellitus.

Fig. 1

The CMR-derived LV strain parameters among controls, T2DM(AR-) and T2DM(AR +) in LV PS(%), PSSR(1/s), PDSR(1/s). *P < 0.05, T2DM vs. Normal; ^#P < 0.05, T2DM patients with AR vs. T2DM patients without AR. T2DM, type2 diabetes mellitus; AR, aortic regurgitation; LV, left ventricular; PS, peak strain; PSSR, peak systolic strain rate; PDSR, peak diastolic strains rate

Fig. 2

Cardiac cine images and three-dimensional pseudo-colour images of LV longitudinal strain in T2DM patients with mild, moderate and severe regurgitation. a–c T2DM patient with severe aortic regurgitation, male, 59 years old, left ventricular short axis (a), four-chamber (b), two-chamber (c), RF = 68.3%; f–h, T2DM with moderate aortic regurgitation, female, 52 years old, left ventricular short axis (f), four-chamber (g), two-chamber (h) cine sequence images showed moderate aortic regurgitation (red arrow), RF = 43.6%; k-m, T2DM patient with mild aortic regurgitation, male, 58 years old, left ventricular short axis (k), four-chamber (l), two-chamber (m), RF = 12.5%. d, i, n and e, j, o were three-dimensional pseudo color maps of left ventricular PS and PSSR in longitudinal. Cine sequence images showed black regurgitation signal from aorta into left ventricle (red arrow). T2DM type 2 diabetes mellitus, RF regurgitation fraction, PS peak strain, PSSR peak systolic strain rate

Fig. 3

Correlation between the regurgitation degree of diabetes and LV global PS. The absolute value of PS was used in the circumferential and longitudinal direction analysis to avoid the influence of directional sign. T2DM type 2 diabetes mellitus, r correlation coefficient