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. 2023 Apr 21;22(1):93.
doi: 10.1186/s12933-023-01806-7.

The right ventricular dysfunction and ventricular interdependence in patients with DM: assessment using cardiac MR feature tracking

Rui Shi  1 , Zhi-Gang Yang  1 , Ying-Kun Guo  2 , Wen-Lei Qian  1 , Yue Gao  1 , Xue-Ming Li  1 , Li Jiang  1 , Hua-Yan Xu  2 , Yuan Li  3
Affiliations

The right ventricular dysfunction and ventricular interdependence in patients with DM: assessment using cardiac MR feature tracking

Rui Shi et al. Cardiovasc Diabetol. .

Abstract

Background: To investigate the difference of right ventricular (RV) structural and functional alteration in patients with diabetes mellitus (DM) with preserved left ventricular ejection fraction (LVEF), and the ventricular interdependence in these patients, using cardiac MR (CMR) feature tracking.

Methods: From December 2016 to February 2022, 148 clinically diagnosed patients with DM who underwent cardiac MR (CMR) in our hospital were consecutively recruited. Fifty-four healthy individuals were included as normal controls. Biventricular strains, including left/right ventricular global longitudinal strain (LV-/RVGLS), left/right ventricular global circumferential strain (LV-/RVGCS), left/right ventricular global radial strain (LV-/RVGRS) were evaluated, and compared between patients with DM and healthy controls. Multiple linear regression and mediation analyses were used to evaluate DM's direct and indirect effects on RV strains.

Results: No differences were found in age (56.98 ± 10.98 vs. 57.37 ± 8.41, p = 0.985), sex (53.4% vs. 48.1%, p = 0.715), and body surface area (BSA) (1.70 ± 0.21 vs. 1.69 ± 0.17, p = 0.472) between DM and normal controls. Patients with DM had decreased RVGLS (- 21.86 ± 4.14 vs. - 24.49 ± 4.47, p = 0.001), RVGCS (- 13.16 ± 3.86 vs. - 14.92 ± 3.08, p = 0.011), and no decrease was found in RVGRS (22.62 ± 8.11 vs. 23.15 ± 9.05, p = 0.743) in patients with DM compared with normal controls. The difference in RVGLS between normal controls and patients with DM was totally mediated by LVGLS (indirect effecting: 0.655, bootstrapped 95%CI 0.138-0.265). The difference in RVGCS between normal controls and DM was partly mediated by the LVGLS (indirect effecting: 0.336, bootstrapped 95%CI 0.002-0.820) and LVGCS (indirect effecting: 0.368, bootstrapped 95%CI 0.028-0.855).

Conclusions: In the patients with DM and preserved LVEF, the difference in RVGLS between DM and normal controls was totally mediated by LVGLS. Although there were partly mediating effects of LVGLS and LVGCS, the decrease in RVGCS might be directly affected by the DM.

Keywords: CMR feature-tracking; Diabetes mellitus; Right ventricular dysfunction; Ventricular interdependence.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Illustration of the color-coded 2D strain for the right ventricle of a DM patient. After right ventricular epi- and endocardial borders were traced in short-axis and 4ch- longitudinal view images on end-systole (a2–c2) and end-diastole (a1–c1), RVGCS (a3), RVGRS (b3), and RVGLS (c3) were automatically generated. ED, end-diastolic; ES, end-systolic; RVGCS, right ventricular global circumferential strain; RVGLS, right ventricular global longitudinal strain; RVGRS, right ventricular global radial strain
Fig. 2
Fig. 2
Comparing LV- and RV strains between patients with DM and normal control. LVGLS: left ventricular global longitudinal strain. LVGCS: left ventricular global circumferential strain. LVGRS: left ventricular global radial strain. NC: normal controls. DM: diabetic mellitus. Data are reported as median (25th–75th percentiles). *: p < 0.05 between DM and NC. **: p < 0.001 between DM and NC. NS: not significant
Fig. 3
Fig. 3
Forest plot: Univariate and Multifactorial analysis of diabetes mellitus on biventricular structural and functional parameters. Abbreviations are consistent with Table 2 and Fig. 2. Multivariable analysis corrected for age, sex, body surface area, history of smoking, history of alcohol consumption, hypertension, hyperlipidemia, FBG, HDL-C, LDL-C, and heart rate
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