A study of the effect of suboptimal glycemic control on subclinical myocardial systolic function in patients with T2DM

doi:10.3969/j.issn.1674-8115.2023.08.010

Abstract

Abstract:

Objective ·To explore the relationship between poor blood glucose control and early impaired cardiac function in patients with type 2 diabetes mellitus (T2DM). Methods ·Eighty-three patients diagnosed with T2DM in Jiading Branch of Shanghai General Hospital from June 2021 to March 2022 were selected and divided into two groups according to the level of hemoglobin A_1c(HbA1c): satisfactory control of glycaemia (SCG) group and less satisfactory control of glycaemia (LSCG) group. Fifty-four subjects were in the control group. Echocardiography was performed to obtain left ventricular structural and functional parameters and left ventricular subendocardial, medial and subepicardial global longitudinal strain (GLS): GLS_endo, GLS_mid, and GLS_epi. The parameters were compared by using analysis of variance. The correlation analysis was performed by Pearson correlation analysis and multiple linear regression analysis. The diagnostic performance of longitudinal strain in differentiating subclinical myocardial dysfunction in patients with T2DM was analyzed by receiver operator characteristic (ROC) curve. Results ·The thickness of the ventricular septum and the posterior wall of the left ventricle were thicker in the LSCG group than in the SCG group and the control group (all P<0.05), but there was no significant difference between the SCG and the control group (all P>0.05). Compared with the control group, the left ventricular diastolic function index E/e (early peak flow velocity by Doppler/early and atrial diastolic velocity of the mitral annulus by tissue Doppler imaging) was higher in both the LSCG group and the SCG group (all P <0.05), but there was no significant difference between the LSCG group and SCG group (P>0.05). There was no significant difference in left ventricular ejection fraction among the three groups (P>0.05). Compared with LSCG group, GLS_endo, GLS_mid and GLS_epi were higher in the SCG group and control group (all P<0.05), but there was no significant difference between the SCG group and control group (P>0.05). HbA_1c was an independently negative factor of GLS_mid and GLS_epi (β= -0.198 and -0.239, all P<0.05). GLS_endo, GLS_mid and GLS_epi had moderate diagnostic performance between the LSCG group and SCG group, with areas under the curve (AUC) of 0.754 (95%CI 0.624?0.884), 0.755 (95%CI 0.624?0.885), and 0.751 (95%CI 0.619?0.882), respectively. Conclusions ·T2DM patients with unsatisfactory glycemic control have reduced myocardial contractility, and this subclinical myocardial damage is independently negatively correlated with the level of HbA_1c.

Key words: echocardiography, type 2 diabetes mellitus (T2DM), strain, hemoglobin A_1c (HbA_1c), two-dimensional speckle tracking imaging

CLC Number:

R540.45

WU Lingheng, CHEN Jianxiong, ZHANG Mengjiao, SHA Lei, CAO Mengmeng, SHEN Cuiqin, DU Lianfang, LI Zhaojun. A study of the effect of suboptimal glycemic control on subclinical myocardial systolic function in patients with T2DM[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(8): 1024-1031.

Figures/Tables 6

TrendMD

References 23

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Item	Control group (n=54)	SCG group (n=17)	LSCG group (n=66)	F/χ² value	P value
Male/n(%)	32 (59.2)	10 (58.8)	40 (60.6)	0.031	0.985
Age/year	54.85±10.62	65.71±7.04^①	60.65±11.93^②	7.839	0.001
Height/cm	164.83±8.12	164.24±7.86	165.74±7.94	0.332	0.718
Weight/kg	63.28±11.15	63.71±13.55	68.32±13.48	2.626	0.076
BMI/(kg·m^-2)	23.23±3.32	23.53±4.24	24.82±4.44	2.499	0.086
SBP/mmHg	127.31±20.80	143.06±24.80^③	143.15±23.84^①	7.868	0.001
DBP/mmHg	78.81±12.11	80.59±15.53	82.76±14.22	1.255	0.288
Pulse/(beats·min^-1)	80.07±12.81	79.47±12.62	79.20±12.89	0.067	0.935
CSBP/mmHg	124.94±17.06	125.71±11.52	129.40±17.24	1.097	0.337
Hypertension/n(%)	0 (0)	3 (17.6)^③	23 (34.8)^①	23.479	0.000

Item	Control group (n=54)	SCG group (n=17)	LSCG group (n=66)	F/χ² value	P value
Male/n(%)	32 (59.2)	10 (58.8)	40 (60.6)	0.031	0.985
Age/year	54.85±10.62	65.71±7.04^①	60.65±11.93^②	7.839	0.001
Height/cm	164.83±8.12	164.24±7.86	165.74±7.94	0.332	0.718
Weight/kg	63.28±11.15	63.71±13.55	68.32±13.48	2.626	0.076
BMI/(kg·m^-2)	23.23±3.32	23.53±4.24	24.82±4.44	2.499	0.086
SBP/mmHg	127.31±20.80	143.06±24.80^③	143.15±23.84^①	7.868	0.001
DBP/mmHg	78.81±12.11	80.59±15.53	82.76±14.22	1.255	0.288
Pulse/(beats·min^-1)	80.07±12.81	79.47±12.62	79.20±12.89	0.067	0.935
CSBP/mmHg	124.94±17.06	125.71±11.52	129.40±17.24	1.097	0.337
Hypertension/n(%)	0 (0)	3 (17.6)^③	23 (34.8)^①	23.479	0.000

Item	Control group (n=54)	SCG group (n=17)	LSCG group (n=66)	F value	P value
TC/(mmol·L^-1)	4.30±1.04	4.44±1.10	4.58±1.26	0.915	0.403
TAG/(mmol·L^-1)	1.41±1.00	1.85±1.04	1.72±1.12	1.745	0.179
HDL-Ch/(mmol·L^-1)	1.10±0.30	1.10±0.37	0.99±0.34	1.785	0.172
LDL-Ch/(mmol·L^-1)	2.85±0.96	2.64±0.93	2.87±1.06	0.348	0.707
FBG/(mmol·L^-1)	5.29±1.28	5.52±1.13	8.30±2.97^①②	29.469	0.000
HbA_1c	5.31±0.82	5.98±0.67	9.19±2.75^①②	60.215	0.000

Item	Control group (n=54)	SCG group (n=17)	LSCG group (n=66)	F value	P value
TC/(mmol·L^-1)	4.30±1.04	4.44±1.10	4.58±1.26	0.915	0.403
TAG/(mmol·L^-1)	1.41±1.00	1.85±1.04	1.72±1.12	1.745	0.179
HDL-Ch/(mmol·L^-1)	1.10±0.30	1.10±0.37	0.99±0.34	1.785	0.172
LDL-Ch/(mmol·L^-1)	2.85±0.96	2.64±0.93	2.87±1.06	0.348	0.707
FBG/(mmol·L^-1)	5.29±1.28	5.52±1.13	8.30±2.97^①②	29.469	0.000
HbA_1c	5.31±0.82	5.98±0.67	9.19±2.75^①②	60.215	0.000

Item	Control group (n=54)	SCG group (n=17)	LSCG group (n=66)	F value	P value
LVEDD/mm	48.09±10.38	46.31±7.41	46.99±7.60	0.366	0.694
LVESD/mm	29.27±3.67	28.64±3.73	33.28±32.92	0.561	0.572
IVSd/mm	8.61±1.02	9.25±1.13	9.48±1.38^①	7.710	0.001
LVPWd/mm	8.52±0.94	8.68±1.16	9.05±1.39^②	2.932	0.057
LVEF/%	0.59±0.09	0.55±0.09	0.56±0.09	1.723	0.183
E/e	6.52±1.64	8.93±3.70^③	8.12±2.93^③	7.991	0.001
e/a	1.16±0.51	0.86±0.42^④	0.82±0.42^⑤	8.467	0.000
GLS_endo/%	-21.35±3.79	-21.88±3.29	-18.46±4.37^⑤⑥	9.532	0.000
GLS_mid/%	-20.27±3.78	-20.75±3.14	-17.47±4.17^⑤⑥	9.489	0.000
GLS_epi/%	-19.22±3.76	-19.56±3.18	-16.23±4.00^⑤⑥	10.966	0.000