Speckle Tracking Imaging Techniques To Evaluate Left And Right Ventricular Myocardial Function In Patients With Type 2 Diabetic Kidney Disease

Part Ⅰ Speckle-tracking imaging technique to evaluate left ventricular systolic function and indoor ventricular systolic synchronization in patients with type 2 diabetic kidney disease with preserved left ventricle ejection fractionObjective: Two-dimensional speck-tracking imaging(2D-STI)was used to calculate the longitudinal stratified strain value and peak strain dispersion of the left ventricular ejection fraction preserved type 2 diabetic kidney disease,To evaluate the systolic function and indoor systolic synchronization of the left ventricle.Methods: A total of 62 patients in T2DM without complicated nephropathy,39 DKD patients and 42 control group were selected.Conventional echocardiographic parameters were obtained,and 2D-STI was used to derive the Longitudinal strain of the LV subendocardial myocardium(LSendo),Longitudinal strain in the middle myocardium(LSmid),Longitudinal strain of the subepicardial myocardium(LSepi),global longitudinal strain(LV GLS),and peak strain dispersion(PSD),compare the differences in the group parameters,and analyze the correlation of LSendo,LSmid,LSepi,and LV GLS with PSD.Fifteen patients were randomly selected for the intra-and inter-observer repeatability tests.Results: Comparison of major echocardiographic parameters showed that T2DM without combined nephropathy group had higher PSD values than control group(P <0.001),while LSendo,LSmid,LSepi,and LV GLS were lower than control group(P <0.001).The DKD group was higher in PSD than the control group and T2DM uncomplicated nephropathy group((P <0.05),while LSendo,LSmid,LSepi and LV GLS were lower than the control group and T2DM uncomplicated nephropathy group(P <0.05).The results of the correlation analysis showed that LSendo,LSmid,LSepi,and LV GLS were all negatively associated with PSD(r=-0.654,P<0.05;r=-0.667,P<0.05;r=-0.674,P<0.05;r=-0.672,P<0.05).Fifteen randomly selected patients with LSendo,LSmid,LSepi,LV GLS,and PSD values showed good intra-and inter-observer repetition.Conclusion: 1.Diabetic patients have elevated blood pressure,abnormal lipid metabolism,cardiac remodeling and subclinical systolic function abnormalities,which are more obvious in patients with impaired renal function.2.2D-STI technology can identify the myocardial systolic function injury of diabetes mellitus or diabetic patients with renal insufficiency before the decrease of left ventricular ejection fraction,which provides an important basis for clinical decision-making and drug therapy,and has a good application prospect.Part Ⅱ Early impairment of right ventricular systolic function in patients with type 2 diabetes and diabetic kidney disease with left ventricular ejection fraction preserved by speckle tracking imagingObjective: Two-dimensional speckle tracking imaging(2D-STI)was used to calculate the longitudinal strain values of the right ventricular myocardium segments and the whole myocardium in patients with type 2 diabetes mellitus(T2DM)and diabetic kidney disease(DKD)with left ventricular ejection fraction retained,and To evaluate the changes of RV systolic function in patients and to explore the utility of 2D-STI technique in RV systolic function.Methods:The control group included 50 patients,60 patients with T2DM and 54 patients with DKD.General clinical data and routine echocardiographic results of each group were obtained.2D STI technique was used to obtain the overall longitudinal strain of the left ventricle(LV GLS),the longitudinal strain of each segment of the right ventricular free wall(apical segment,middle segment,and base segment),the total free wall strain of the right ventricle(RV-FWLs)and the overall longitudinal strain of the right ventricle(RV GLS).Compare the differences of the above parameters.Results: The main echocardiographic results showed that there were no significant differences in systolic displacement(TAPSE),peak systolic velocity(RV-S ’)and myocardial work index(TEI index)among the three groups.The change rate of right ventricular area(FAC)in DKD group was lower than that in control group(P<0.05),but had no statistical difference compared with T2DM group without renal damage.LV GLS,RV free wall intermediate strain,RV-FWLs and RV GLS decreased gradually from control group to T2DM group without renal damage and then to DKD group(P<0.05).The basal segment strain of RV free wall in T2DM group without renal damage was lower than that in control group(P<0.05).The RV free wall apical and basal segment strains in DKD group were lower than those in control group(P<0.05),but there was no significant difference compared with T2DM without renal damage.Conclusions: 1.Diabetic patients have local RV systolic dysfunction without significant changes in cardiac configuration,and have more obvious impairment in patients with renal dysfunction.2.Speckle-tracking echocardiography can better identify subtle RV systolic dysfunction in type 2 diabetes mellitus and diabetic kidney disease in patients than conventional echocardiography.