The right ventricular dysfunction and ventricular interdependence in patients with T2DM and aortic regurgitation: an assessment using CMR feature tracking

Abstract

Background: Patients with concomitant type 2 diabetes mellitus (T2DM) and aortic regurgitation (AR) can present with right ventricular (RV) dysfunction. The current study aimed to evaluate the impact of AR on RV impairment and the importance of ventricular interdependence using cardiac magnetic resonance feature tracking (CMR‑FT) in patients with T2DM.

Methods: This study included 229 patients with T2DM (AR-), 88 patients with T2DM (AR+), and 122 healthy controls. The biventricular global radial strain (GRS), global circumferential strain (GCS), and global longitudinal peak strain (GLS) were calculated with CMR‑FT and compared among the healthy control, T2DM (AR-), and T2DM (AR+) groups. The RV regional strains at the basal, mid, and apical cavities between the T2DM (AR+) group and subgroups with different AR degrees were compared. Backward stepwise multivariate linear regression analyses were performed to determine the effects of AR and left ventricular (LV) strains on RV strains.

Results: The RV GLS, LV GRS, LV GCS, LV GLS, interventricular septal (IVS) GRS and IVS GCS were decreased gradually from the controls through the T2DM (AR-) group to the T2DM (AR+) group. The IVS GLS of the T2DM (AR-) and T2DM (AR+) groups was lower than that of the control group. AR was independently associated with LV GRS, LV GCS, LV GLS, RV GCS, and RV GLS. If AR and LV GLSs were included in the regression analyses, AR and LV GLS were independently associated with RV GLS.

Conclusion: AR can exacerbate RV dysfunction in patients with T2DM, which may be associated with the superimposed strain injury of the left ventricle and interventricular septum. The RV longitudinal and circumferential strains are important indicators of cardiac injury in T2DM and AR. The unfavorable LV-RV interdependence supports that while focusing on improving LV function, RV dysfunction should be monitored and treated in order to slow the progression of the disease and the onset of adverse outcomes.

Keywords: Aortic regurgitation; CMR feature‑tracking; Right ventricle; Strain; Type 2 diabetes mellitus; Ventricular interdependence.

Fig. 1

Examples of evaluations of left and right ventricular global strains using CMR-FT. A–C, the endo- and epicardial contours of the left and right ventricles are delineated on standard cardiac short-axis, two-chamber, and four-chamber planes in end diastole D–I, global longitudinal strains of the left (D–F) and right (G–I) ventricles among control, T2DM (AR−) group, and T2DM (AR+) group. The yellow and blue curves represent the endo- and epicardial contours of the right ventricle, and the red and green curves represent those of left ventricle. T2DM, type 2 diabetes mellitus; AR, aortic regurgitation; LV, left ventricular; RV, right ventricular

Fig. 2

Comparing LV-, IVS- and RV strains among controls, T2DM (AR−) group, and T2DM (AR+) group. T2DM, type 2 diabetes mellitus; AR, aortic regurgitation; LV, left ventricular; IVS, interventricular septum; RV, right ventricular; GRS, global radial strain; GCS, global circumferential strain; GLS, global longitudinal strain

Fig. 3

Regression plots of the correlation between RV PS and LV PS. (a) RV GRS vs. LV GRS; (b) RV GCS vs. LV GCS; (c) RV GLS vs. LV GLS; (d) RVEF vs. IVS GRS; (e) RVEF vs. IVS GCS; (f) RVEF vs. IVS GLS. LV, left ventricular; RV, right ventricular; IVS, interventricular septum; GRS, global radial strain; GCS, global circumferential strain; GLS, global longitudinal strain