The Study On Left Ventricular Function In Diabetes Mellitus By Real-Time Triplane Tissue Doppler Imaging And The Relationship Between Left Ventricular Function And Hemoglobin A1c

Backgroud:Diabetes mellitus (DM) is a chronic metabolic syndrome characterized by long-term persistent hyperglycemia.Recently,The incidence of DM in China particularly type 2 is rising,and cardiovascular complications are known to be the main cause of death and morbidity in elderly diabetic patients.Cardiac function evaluation is important guidance in diagnosing,therapeutic effect, prognostic assessment of cardiovascular disease.Tissue Doppler Imaging(TDI) has been used more and more widely in the evaluation of global and regional systolic and diastolic function of myocardial.TDI has the technology of Quantitative tissue velocity imaging(QTVI),Strain and Strain Rate Imaging(SI and SRI),Tissue Tracking(TT) and Tissue Synchrony Imaging(TSI) and so on.Real-time triplane echocardiography(RT-3PE) is feasible with simple and rapid image acquisition,and accurate time acquisition.Combining RT-3PE and TDI can able to detect cardiac dysfunction in earlier period.The incidence of cardiovascular disease in type 2 diabetes patients is not be a good control,owing to the blood glucose control with non-compliance.Glycisylated hemoglobin A1c (HbA1c) is a certain special structure of hemoglobin and glucose-based combination of non-enzymatic,it is the blood glucose "gold standard".Currently study the relationship between left ventricular function and HbAlc little in the domestic. Objective:(1)To evaluate LV globe and regional heart function changes in patients with type 2 diabetes mellitus using real-time triplane tissue doppler imaging;(2)To discuss the important clinical value of real-time triplane quantitative tissue velocity imaging and strain rate imaging in quantitatively evaluating left ventricular function;(3)To evalute the relationship between cardiac function change and the level of hemoglobin A1c.Subjects and Methods:50 patients who visited Endocrine Research Institute in our hospital from may,2009 to October,2009,were diagnosed type 2 Diabetes mellitus and underwent observation and treatment(they are not associated with cardiovascular disease and metabolic diseases affecting myocardial function such as liver,lung,kidney and bone.50 age-and sex-matched normal controls were enrolled(without history of cardiovascular diseases or other organic diseases,with normal ECG,X-ray and echocardiography).GE Vivid 7 ultrasound system collected conventional two dimension ultrasound and the mitral value inflow at rest, using real-time triplane echocardiography,it can obtained apical four chamber,apical two chamber and apical long axis view.Systolic peak velocity (Vs),early diastole peak velocity(Ve),late diastole peak velocity(Va) were measured at the mitral annulus,basal segment and middle segment of six walls using quantitative tissue telocity imaging(QTVI); peak strain rate of systole(SRs),peak strain rate of early diastole(SRe), peak strain rate of late diastole(SRa) were measured at the basal segment and middle segment using strain rate imaging(SRI);Each parameter were measured three cardiac cycle and average values were obtained.HbAlc of DM2 patients were determined,and evaluated the relationship between cardiac function change and the level of hemoglobin A1c.Results:1. There were no significant differences in systolic indexes (EF,FS,Sm) between the two groups (P>0.05).Em and Em/Am were lower in DM2 group than control group. Am and E/Em were higher in DM2 group than control group(P<0.05或P<0.01).2.The Vs was lower in DM2 group than control group in four segments(the basal segments of lateral,inferior,anterior,posterior), SRs was lower in DM2 group than control group in most segments(except the middle segment of posterior)(P<0.05或P<0.01). The Ve,SRe were lower in DM2 group than control group,Va,SRa were higher in DM2 group than control group(P<0.05或P<0.01).3.HbA1c was negatively correlated with E/A (r=—0.435, P<0.05), Em (r=—0.472, P<0.01), Em/Am (r=—0.519, P<0.01) and positively correlated with E/Em (r=0.579, P<0.05).Conclusion:1. The real-time triplane tissue doppler imaging can detect the early impairment of cardiac function in DM2 patients,in the normal ejection fraction,left ventricular global diastolic and regional systolic and diastolic function reduced;The diastolic dysfunction exist before the systolic function damage in DM2 patients.2.Triplane-SRI is used to evaluate regional myocardial function, Triplane-QTVI is used to evaluate regional and global myocardial function,if they are combined with each other,then evaluate cardiac function better.3.Left ventricular diastolic dysfunction is related with HbAlc, According to HbAlc can understand impaired diastolic function in DM2 patients.