Echocardiography Was Used To Evaluate Early Left Ventricular Diastolic Function In Patients With Type 2 Diabetes Mellitus

Objective:Echocardiography was used to evaluate the early left ventricular diastolic function in patients with type 2 diabetes mellitus(T2DM)and healthy subjects,so as to provide a strong basis for early and long-term clinical intervention.Methods:The subjects of this study were 54 T2 DM patients admitted to the Department of Cardiology,The Second Hospital of Shanxi Medical University from January 2021 to January 2022.Their clinical data were retrospectively analyzed,which all met the diagnostic criteria and typing criteria of T2 DM formulated by WHO in 1999.Fifty-four healthy persons who underwent physical examination in our hospital during the same period were selected as the control group.All of them had no metabolic diseases,endocrine diseases,cardiopulmonary diseases,and no family history of hypertension and coronary heart disease according to clinical physical examination and imaging examination.There was no significant difference in the basic data between the two groups(P > 0.05).Echocardiography was used to measure various indexes of left ventricular function in both groups.Left ventricular posterior wall thickness(LVPWT),left ventricular end diastolic and end systolic diameter(LVDd,LVDs),ventricular septal thickness(IVST),left atrial diameter(LAD),left ventricular ejection fraction(EF%)and left ventricular short axis shortening rate(FS%)were measured on the standard section of left ventricular long axis.The left ventricular myocardial mass index(LVMI)was calculated automatically by ultrasonic diagnostic instrument.The volume of the left atrium(LAV)was measured and the related index(LAVI)was calculated.The color Doppler technique was used to measure the early and late diastolic peak velocity(E,A),the early diastolic peak deceleration time(DT),the constant volume diastolic period(IVRT),and the E/A value was calculated.The early and late diastolic peak motion velocity(Em,Am)was measured using tissue Doppler TDI model,and the mean Em/Am and E/Em at the lateral wall and posterior septum of mitral valve were calculated.The center of the mitral valve was measured by M-mode ultrasound.The main index was left ventricular inflow tract color Doppler flow velocity(FPV).The peak time(Td)of the mitral valve and papillary muscle in early diastolic phase was measured.On the machine,the a CMQ software of the instrument was opened to detect the Diastolic strain rate(SR)of the two groups.After manual adjustment of each section mode,the software would automatically track the left ventricular wall of each section,and the strain-time and strain-rate-time curves would be generated automatically.After obtaining the overall early diastolic peak strain rate(Lg SRe)and late diastolic peak strain rate(Lg SRa),Lg SRe/Lg SRa was calculated,and E/Lg SRe ratio was calculated with the diastolic flow spectrum of the mitral valve.Results:1.There were no statistically significant differences in gender,age,smoking history,BSA,HR,TC,LDL-C,HDL-C,DBP and SBP between the two groups(P > 0.05),but the levels of FPG,2h PG,Hb A1 c,HOMA-IR and TG in T2 DM group were significantly higher than those in control group.The difference was statistically significant(P < 0.05).2.The detection rate of Em/Am≤0.8 in T2 DM patients by TDI mode was 81.48%,and that of E/A≤0.8 by color Doppler was 38.89%,the difference was statistically significant(P < 0.05).3.There was no significant difference in LVDd,EF% and FS% between the two groups(P > 0.05).There were statistically significant differences in LVPWT,LAD,LVMI,IVST,E,A,Em,Am,E/A,Em/Am,E/Em,DT,IVRT,LAVI and FPV between T2 DM group and control group(P < 0.05).4.Diastolic Td of left ventricular mitral valve in T2 DM group was significantly slower than that in control group(P < 0.05).The Td of anterior and posterior wall,inferior wall,lateral wall and anterior and posterior septum in T2 DM group was significantly slower than that in control group,with statistical significance(P < 0.05).5.The overall SR of two/three/four chambers in early diastolic apex and left ventricle in T2 DM group was significantly lower than that in control group,with statistical significance(P < 0.05).There was no significant difference in late diastolic SR between the two groups(P > 0.05).The longitudinal E/lg SRe ratio in T2 DM group was significantly higher than that in control group,while the lg SRe /Lg SRa ratio was significantly lower than that in control group,with statistical significance(P < 0.05).Conclusion:1.Left ventricular diastolic dysfunction in T2 DM patients has already occurred in the early stage of the disease,so it is necessary to pay attention to the screening and early systematic intervention of left ventricular diastolic dysfunction in T2 DM patients.2.In echocardiography,Em/Am < 1 was favorable for detecting left ventricular diastolic dysfunction.LAVI confirmed that left ventricular diastolic dysfunction appeared earlier than systolic dysfunction.Td value of left ventricular wall movement can reflect diastolic function,which is convenient for clinical evaluation of left ventricular function.SR index can reflect ventricular wall movement velocity,and then reflect the impaired local myocardial diastolic function in early T2 DM patients.3.Combined use of multiple echocardiography techniques and indicators can more accurately evaluate the early left ventricular diastolic function of T2 DM patients,and can provide early monitoring of diabetic myocardial damage,so as to reduce the risk of severe diabetic heart disease and death.