The Study Of The Non-invasive Techniques Used In Diabetic Heart Disease

Objective To study the mitral annular(MA)systolic displacement,MA systolic tilting motion and regional myocardial systolic function in newly diagnosed type 2 diabetes using CDMI data.To study the gender differences and effect of aging in the heart rate variability among newly diagnosed type 2 diabetic subjects,the association of nephropathy with reduced time domain analysis of heart rate variability in patients with type 2 diabetes,the association of serum adiponectin concentrations with reduced analysis of HRV in non diabetic offspring of type 2 diabetic patients and the association of modified ECG with reduced time domain analysis of heart rate variability in older patients with newly diagnosed type 2 diabetes.Methods We studied 28 healthy endurance trained male athletes,28 age- and sex- matched controls, 57 diabetes and 60 controls.All subjects underwent a standard two-dimensional and Doppler echocardiographic examination at rest in the left lateral supine position.The same examination was performed in athletes after exercise stress.We defined the MA as two intersecting lines,one drawn from the septal wall to the lateral wall in the apical 4-chamber view and one drawn from the anterior wall to the inferior wall in the apical 2-chamber view.We assumed that these two lines were perpendicular to the cardiac walls at ED and oblique at ES.The oblique angles from their original position of ED were the systolic MA tilting angles.These angles could be calculated by the formulae.ANG a4 and ANG a2 represented the systolic MA tilting angle in the apical 4-chamber and 2-chamber views.Three consecutive heart cycles were stored in a cine-loop format and transferred to a personal computer for off-line analysis.CDMI clips were analysed with custom-made software(Speqle 4.02,K.U.Leuven,Belgium) allowing accurate timing of global events in the cardiac cycle.The integration of the regional velocity curve will derive the regional displacement curve.From the resulting velocity,strain rate and strain curves,peak systolic velocity,peak systolic strain rate,and end-systolic strain were extracted for each analyzed segment.We examined HRV indices determined from 24-h Holter recording in(1)391 patients with newly diagnosed type 2 diabetes.(2)308 patients with type 2 diabetes(All patients were divided into three groups:normal,micro- and clinical albuminuria.)(3) 67 of the 91 offspring of 31 type 2 diabetic subjects(FPG≤5.6mmol/L,which were divided into two groups according to the outcomes of oral glucose tests(normal glucose tolerance(NGT)group(n=32)and impaired glucose tolerance(IGT)group (n=35).Twenty- five control subjects were recruited for the study.Serum adiponectin concentrations were measured.(4)196 older patients with newly diagnosed type 2 diabetes.Compare the incidences of normal ECG,abnormal ST-T and abnormal Q wave between the up quartile group and the low quartile group of each time domain HRV indices.Results(1)Neither in apical 4-chamber view nor in apical 2-chamber view,could significant differences of mitral annulus tilting angle be found between the athlete and control groups.Compared to the resting state,ANG a4, ANG a2 and heart rate(HR)were increased in this situation.D lat is the major related factor of ANG a4.ANG a4 demonstrated negative correlation with D lat,DIA a4,D ant,and positively with HR.D ant is the major related factor of ANG a2.ANG a2 demonstrated negative correlation with D ant,DIA a4,D lat,and positively with HR. ANG a4 and ANG a2 had a significant correlation.Compared with controls,MA systolic tilting angle were decreased in diabetic group both in apical 4-chamber view and in apical 2-chamber view.Neither in apical 4-chamber view nor in apical 2-chamber view,could significant differences of MA systolic displacement and peak systolic velocity of regional myocardial segment be found between the diabetes and control groups.Peak systolic strain rate,and end-systolic strain were decreased in diabetic group.(2)HRV time domain parameters(SDNN,SDANN,SDNNI)were especially impaired in diabetic women compared with diabetic men under 60 years old.SDNN,SDANN,SDNNI negatively correlated with aging in female.SDNN, SDANN,SDNNI,rMSSD,PNN₅₀negatively correlated with aging in male.(3)There are significant differences in age,total cholesterol,triglyceride,LDL-C between clinical albuminuria and the rest two groups,in blood pressure and pulse pressure within the three groups.HRV time domain parameters(SDNN,SDANN,SDNNI) were especially impaired in clinical albuminuria group.(4)There are significant differences in SDNN,SDANN,rMSSD,TP,LF,HF,fasting insulin and adiponectin concentrations within the three groups,in BMI,TG,HDL-c between IGT and the rest two groups.Serum adiponectin concentrations in non diabetic offspring of type 2 diabetic patients were negatively correlated with BMI,fasting insulin concentration, and positively correlated with HDL-c,SDNN,SDANN,rMSSD,TP,LF,HF.(5) There are significant differences in the distribution of the incidences of normal ECG, abnormal ST-T and abnormal Q wave between the up quartile group and the low quartile group of SDNN,SDANN,SDNNI,rMSSD.Conclusions The results of the present study demonstrate that CDMI is able to be used in the study of mitral annular systolic tilting motion.And the mitral annular systolic tilting motion may have important roles in health and in diabetic states.Newly diagnosed type 2 diabetes has an age and gender-specific impact on the HRV.There was an association of reduced time domain analysis of HRV with diabetic nephropathy.The autonomic impairment is associated with insulin resistant and the altered serum adiponectin concentrations.Low HRV contributes to the change of conventional ECG in older patients with newly diagnosed type 2 diabetes.