Journal of Shanghai Jiao Tong University (Medical Science) >

2023 , Vol. 43 >Issue 8: 1024 - 1031

DOI: https://doi.org/10.3969/j.issn.1674-8115.2023.08.010

Clinical research

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

  • Lingheng WU ,
  • Jianxiong CHEN ,
  • Mengjiao ZHANG ,
  • Lei SHA ,
  • Mengmeng CAO ,
  • Cuiqin SHEN ,
  • Lianfang DU ,
  • Zhaojun LI
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  • 1.Department of Ultrasound, Mindong Hospital Affiliated to Fujian Medical University, Ningde 355000, China
    2.Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
    3.Department of Medical Imaging, Weifang Medical University, Weifang 261053, China
    4.Department of Ultrasound, Jiading Branch of Shanghai General Hospital, Shanghai 201803, China
LI Zhaojun, E-mail: lzj_1975@sina.com.

Received date: 2023-04-01

  Accepted date: 2023-07-21

  Online published: 2023-08-28

Supported by

Natural Science Foundation of Shanghai(21ZR1451400);Shanghai Health and Family Planning Commission Fund(202240235);Shanghai Jiading District Health and Family Planning Commission Fund(2021-KY-10);Startup Fund for scientific research, Fujian Medical University(2022QH1232)

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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 A1c (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): GLSendo, GLSmid, and GLSepi. 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, GLSendo, GLSmid and GLSepi 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). HbA1c was an independently negative factor of GLSmid and GLSepi (β= -0.198 and -0.239, all P<0.05). GLSendo, GLSmid and GLSepi 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 HbA1c.

Key words： echocardiography; type 2 diabetes mellitus (T2DM); strain; hemoglobin A1c (HbA1c); two-dimensional speckle tracking imaging

Cite this article

Lingheng WU , Jianxiong CHEN , Mengjiao ZHANG , Lei SHA , Mengmeng CAO , Cuiqin SHEN , Lianfang DU , Zhaojun LI . 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 . DOI: 10.3969/j.issn.1674-8115.2023.08.010

References

1 SAEEDI P, PETERSOHN I, SALPEA P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition[J]. Diabetes Res Clin Pract, 2019, 157: 107843.
2 MA R C W. Epidemiology of diabetes and diabetic complications in China[J]. Diabetologia, 2018, 61(6): 1249-1260.
3 RITCHIE R H, ABEL E D. Basic mechanisms of diabetic heart disease[J]. Circ Res, 2020, 126(11): 1501-1525.
4 LEE S R, LIU T, ZHOU J D, et al. Predictions of diabetes complications and mortality using hba1c variability: a 10-year observational cohort study[J]. Acta Diabetol, 2021, 58(2): 171-180.
5 严霜霜, 尹立雪, 张红梅, 等. 超声分层应变技术评价血液透析患者左心室跨壁心肌收缩功能损伤[J]. 中华超声影像学杂志, 2019, 28(3): 205-210.
5 YANG S S, YIN L X, ZHANG H M, et al. Evaluation of left ventricular systolic transmural myocardial dysfunction of maintenance hemodialysis patients using ultrasonic layer-specific strain technology[J]. Chinese Journal of Ultrasonography, 2019, 28(3): 205-210.
6 薛衍敏, 潘翠珍, 李政, 等. 分层二维斑点追踪显像技术评价糖尿病患者左室心肌各层收缩功能的变化[J]. 中华超声影像学杂志, 2015(12): 1024-1027.
6 XUE Y M, PAN C Z, LI Z, et al. Evaluation of left ventricular strain in diabetic patients using layer-specific two-dimensional speckle tracking imaging[J]. Chinese Journal of Ultrasonography, 2015(12): 1024-1027.
7 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4): 315-409.
7 Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)[J]. Chinese Journal of Diabetes, 2021, 13(4): 315-409.
8 中国高血压防治指南修订委员会. 中国高血压防治指南(2005年修订版)[M].北京: 人民卫生出版社, 2005: 1-47.
8 Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension. 2005 Chinese Guidelines for Prevention and Treatment of Hypertension[M]. Beijing: People's Medical Publishing House, 2005: 1-47.
9 中国医师协会超声医师分会心脏超声专业委员会. 二维斑点追踪超声心动图心肌纵向应变规范化检查中国专家共识(2023版)[J]. 中华超声影像学杂志, 2023, 32(4): 277-287.
9 Echocardiography Committee of Chinese Ultrasound Doctor Association. Chinese expert consensus on standardized myocardial longitudinal strain imaging using two-dimensional speckle-tracking echocardiography (version 2023)[J]. Chinese Journal of Ultrasonography, 2023, 32(4): 277-287.
10 RAGHAVAN S, VASSY J L, HO Y L, et al. Diabetes mellitus-related all-cause and cardiovascular mortality in a national cohort of adults[J]. J Am Heart Assoc, 2019, 8(4): e011295.
11 MUSHA I, MOCHIZUKI M, KIKUCHI T, et al. Estimation of glycaemic control in the past month using ratio of glycated albumin to HbA1c[J]. Diabet Med, 2018, 35(7): 855-861.
12 LU T P, CHATTOPADHYAY A, LU K C, et al. Develop and apply electrocardiography-based risk score to identify community-based elderly individuals at high-risk of mortality[J]. Front Cardiovasc Med, 2021, 8: 738061.
13 WILLIAMS D, STOUT M J, ROSENBLOOM J I, et al. Preeclampsia predicts risk of hospitalization for heart failure with preserved ejection fraction[J]. J Am Coll Cardiol, 2021, 78(23): 2281-2290.
14 SHAH A S, KHOURY P R, DOLAN L M, et al. The effects of obesity and type 2 diabetes mellitus on cardiac structure and function in adolescents and young adults[J]. Diabetologia, 2011, 54(4): 722-730.
15 VUKOMANOVIC V, SUZIC-LAZIC J, CELIC V, et al. The relationship between functional capacity and left ventricular strain in patients with uncomplicated type 2 diabetes[J]. J Hypertens, 2019, 37(9): 1871-1876.
16 ROONEY M R, TANG O, PANKOW J S, et al. Glycaemic markers and all-cause mortality in older adults with and without diabetes: the Atherosclerosis Risk in Communities (ARIC) study[J]. Diabetologia, 2021, 64(2): 339-348.
17 林静茹, 吴伟春, 王浩. 超声心肌应变在射血分数保留型心力衰竭中的应用进展[J]. 中华超声影像学杂志, 2021(12): 1096-1099.
17 LIN J R, WU W C, WANG H. Application progress of echocardiographic myocardial strain in heart failure with preserved ejection fraction[J]. Chinese Journal of Ultrasonography, 2021(12): 1096-1099.
18 李朝军, 康春松, 薛继平, 等. 应用超声技术研究Ⅱ型糖尿病患者心脏-血管耦联[J]. 中华超声影像学杂志, 2012, 21(9): 757-761.
18 LI Z J, KANG C S, XUE J P, et al. Study on ventricular-arterial coupling in patients with type 2 diabetes mellitus by ultrasound[J]. Chinese Journal of Ultrasonography, 2012, 21(9): 757-761.
19 ZHAOJUN L M, QIAN Z M, QING Y M, et al. Gender difference in ventricular-vascular coupling in response to exercises in medical graduate students[J]. Adv Ultrasound Diagn Ther, 2017, 1(1): 1.
20 JIA G H, WHALEY-CONNELL A, SOWERS J R. Diabetic cardiomyopathy: a hyperglycaemia- and insulin-resistance-induced heart disease[J]. Diabetologia, 2018, 61(1): 21-28.
21 J?RGENSEN P G, JENSEN M T, BIERING-S?RENSEN T, et al. Burden of uncontrolled metabolic risk factors and left ventricular structure and function in patients with type 2 diabetes mellitus[J]. J Am Heart Assoc, 2018, 7(19): e008856.
22 BOGDANOVI? J, A?ANIN M, KRLJANAC G, et al. Impact of acute hyperglycemia on layer-specific left ventricular strain in asymptomatic diabetic patients: an analysis based on two-dimensional speckle tracking echocardiography[J]. Cardiovasc Diabetol, 2019, 18(1): 68.
23 SKALI H, SHAH A, GUPTA D K, et al. Cardiac structure and function across the glycemic spectrum in elderly men and women free of prevalent heart disease: the Atherosclerosis Risk in the Community study[J]. Circ Heart Fail, 2015, 8(3): 448-454.
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