Assessment Of Myocardium In Patients With Diabetes Mellitus By Strain Rate Imaging And Integrated Backscatter

【topic origin】Because this topic research belongs to the optional topic,therefore scientific research work march completes in the parent unit.The healthy subjects(normal group) and patients with type 2 diabetes mellitus(2-DM) were extracted from the hospital outpatient service and in hospital.【objective and significance】1.objective:Collecting two-chamber,four-chamber and apical long axis views of thirty normal group and thirty patients with 2-DM,to assess the left ventricular regional systolic and diastolic function in patients with 2-DM by myocardial strain rate imaging(SRI),and discuss the clinic value -f the left ventricular regional myocardium in patients with 2-DM by integrated backscatter(IBS).2.significance:To determine the left ventricular regional lnyocardium in patients with 2-DM by SRI and IBS,for the clinical diagnosis,the treatment,the appraisal prognosis curative effect provide the objective quantification index.【Materials and Methods】1.object of study1)2-DM group:According to diabetes mellitus diagnosed the standard announced by World Health Organization(WHO) in 1999,namely symptom and stochastic blood sugar＞11.1 mmol/L(2g/l),or empty stomach blood plasma glucose＞7.0 mmol/L(1.26 g/l),or in the load test 2 hours blood plasma glucose＞11.1 mmol/L(2g/l).Selecting patients with 2-DM,who all come from in hospital and the outpatient service in No.153 Central Hospital of the Chinese People's Liberation Army,had diagnosed on clinic also,removed heart organic pathological chartges(for example the coronary disease,hypertension and so on,and other system pathological change affects the heart(for example thyroid gland disease,nephrosis and so on), altogether 30 examples,male 19 examples,female 11 examples,average age (49.17±11.74) year old.2)normal group:Elect non-diabetic subjects from the outpatient service,non-heart illness after each inspection(electrocardiogram,echocardiogram),had not hypertension,kidney disease,also for Dou heart rhythm health 30 examples,male 18 examples,female 12 examples,average age(51.33±9.57) year old.2.instrumentUse SONOS 7500 color ultrasonic diagnostic equipment produced by PHILIPS company,S₄ ultrasonic probe,frequence 1.0-3.0MHZ.The SONOS 7500 color ultrasonic diagnostic equipment has Philips the QLAB3.0 workstation,may quantitative analyse Doppler tissue imaging(DTI),Draws the myocardic strain rate and strain curve automatically,also may quantitative analyse strain rate parameter of myocardic segments in cardiac cycles.In addition,the SONOS 7500 color ultrasonic diagnostic equipment has the analysis software of acquisition densitometry(AD) and magnetism compact disc recording system.3.methods1)conventional echocardiogram inspectionThe inspected subject(the patient of 2-DM and the health) took left side decubitus,with the tranquil breath,connected electrocardiogram,took the standard parasternal left ventricular long axis view.Left ventricular ejection fraction(EF%), left ventricular fractional shortening(FS%),left ventricular stroke volume(SV),thickness of interventricular septum at the end of systole,thickness of left ventricular posterior wall at the end of systole,thickness of interventricular septum at the end of diastole,thickness of left ventricular posterior wall at the end of diastole are measured by M-ultrasonic.Compute the thicken ratio of the left ventricular wall(ΔT%),namelyΔT%equivalent thickness of interventricular septum at the end of systole(thickness of left ventricular posterior wall at the end of systole) substract thickness of interventricular septum at the end of diastole (thickness of left ventricular posterior wall at the end of diastole),again divide thickness of interventricular septum at the end of systole(thickness of left ventricular posterior wall at the end of systole).EF%,FS%,SV,ΔT%are indices of left ventricular overall systolic function.Take the standard apical four-chamber views,Pulsed Doppler echocardiography(PDE) recorded the diastolic transmitral flow velocity.Transmitral peak flow velocity in early diastole(Ve) and atrial systole(Va) were examined,and Ve/Va ratio were calculated.Ve,Va,Ve/Va are indices of left ventricular overall diastolic function.EF%,FS%,SV,ΔT, Ve,Va,Ve/Va take the average of three cardiac cycle.2) myocardial strain rate curve and valueThe inspected subject took left side decubitus,with the tranquil breath, connects electrocardiogram.Equipment was transfered to the DTI condition.To avoid the error which the angle produced,the image depth and sample frame were as far as possible small;The sound beam direction was as far as possible consistent with the myocardial heading,the most wide angle cannot surpass 20°.After gathering the left ventricular two-chamber(inferior wall,anterior wall),four-chamber(posterior interventricular septum,lateral wall) and apical long axis(anterior interventricular septum,posterior wall) views′the dynamic images in continual three cardiac cycle.All images were stored in the magnetism compact disc,assigned out the memory image from the magnetism compact disc,Philips QLAB3.0 workstation quantitative analysed the images,.Take a sample frame to put in the middle of myocardium of the left ventricular inferior wall,anterior wall,posterior interventricular septum,lateral wall,anterior interventricular septum,posterior wall separately,carry on manual way to adjust sample frame position by the frame,the system will be automatic draw this segment myocardial velocity,strain and strain rate curve,measure the peak strain rate in systolic period(SRs),the peak strain rate in early diastolic period(SRe) and the peak strain rate in later diastolic period(SRa) of each segment in the curve separately..SRs,SRe,SRa take the average of three cardiac cycle.3) myocardial integrated backscatter parameterThe inspected subject took left side decubitus,with the tranquil breath, connects electrocardiogram,took the standard parasternal left ventricular long axis view.Equipment was transferd to the AD-IBS analysis condition.The sampling fixed depth is 14 centimeter,the fixed gain is 64 dB,the equipment condition was invariable in the entire experimental study process,62 images were stored in the compact disc by the Loop form in continuous 2.48S,after would be analysed off equipment.When off equipment analysis took the sample frame shape to use the meniscus,the concave faces the left ventricular cavity,the sample frame long axis was vertical in the ventricular wall heading.The sample frame size was 21×21 element.Take the sample frame to put in the middle of myocardium of the interventricular septum and the left ventricular posterior wall and the left ventricular cavity center separately,avoid the endocardium,the epicardium as far as possible and the disturbance of the bright acoustic ray signal.The time averaged value of IBS(AII),namely average of integrated backscatter in myocardium cardic cycle time was demonstrated automatically by the machine.Cyclic variation of myocardical integrated backscatter(CVIB),namely myocardial IBS at the end of diastole substract myocardial IBS at the end of systole,demonstrated automatically by the machine. Calculate the calibrated time averaged value of IBS(IBS%),namely percentage ratio of AII and IBS value of the left ventricular cavity in identical sound beam scan line. Calculate the calibrated CVIB(CVIB%),namely percentage ratio of CVIB and AII. AII,IBS%,CVIB,CVIB%take the average of three cardiac cycle.4.statistics analysisApplied SPSS13.0 software packages carry on statistics processing,each measurement data indicated by the mean value±standard deviation,adopting the group the data comparison uses the independent sample T-test,P＜0.05 considered to indicate statistics significance.【Result】1.Conventional echocardiogram material comparative analysis1) indices of left ventricular overall systolic function:In 2-DM group and normal group,EF%,FS%,SV,ΔT%are all in normal range,two group of difference have not statistics significance.2) indices of left ventricular overall diastolic function:In 2-DM group and normal group,Ve obviously decreases,Va obviously recreases,the ratio of Ve and Va obviously decreases,two group of differences have statistics significance (P＜0.05).2.Myocardial SR indices comparative analysisCompared with the normal group,the 2-DM group myocardial SRs of the left ventricular inferior wall,anterior wall,posterior interventricular septum,lateral wall, anterior interventricular septum,posterior wall obviously decreases,SRe obviously decreases,SRa obviously increases,two group of differences have statistics significance(P＜0.05).3.Myocardial IBS parameters comparative analysisThe normal group interventricular septum and the left ventricular posterior wall myocardial IBS curve assumes the periodic variation,at the end of diastole is biggest, at the end of contraction is smallest,approximates the sine curve type;The 2-DM group interventricular septum and the left ventricular posterior wall myocardial IBS curve also assumes the periodic variation,but changes amplititude contraction. Compared with the normal group,the 2-DM group myocardial IBS,IBS%obviously increases,CVIB and CVIB%obviously decreases,two group of differences have statistics significance(P＜0.05).【Conclusions】1.SRI is a newly developed ultrasonic technique base on the Doppler tissue imaging,SR(SRs,SRe,SRa) as the new quantification index to evaluate regional myocardial functiont,has overcome the heart overall movement(for example rotary motion) and the passive drag from the muscle around them,which have an influence on the ventricular wall velocity of movement.Compared with traditional appraisal of the left ventricle overall systolic and diastole function,SRI may timely reflect left ventricular myocardial regional systolic and diastole function of 2-DM patient.2.IBS is a sure ultrasonic tissue character(UTC) new technology.IBS parameter curve is determined by the new AD system,can quantitatively analyse UTC of myocardium.Compared with the conventional ultrasonic inspection technology,IBS can more sensitively and objectively reflect left ventricular myocardial histological change in 2-DM patient.