Assessment of subclinical left ventricle myocardial dysfunction using global myocardial work in type 2 diabetes mellitus patients with preserved left ventricle ejection fraction

Abstract

Background The purpose of this study was to assess subclinical left ventricle (LV) myocardial dysfunction using global myocardial work (MW) in type 2 diabetes mellitus (T2DM) patients with preserved left ventricle ejection fraction (LVEF). Methods Sixty T2DM patients and 60 normal controls were enrolled in the study. Apical 4-, 3- and 2-chamber views were acquired by two-dimensional echocardiography. Peak systolic myocardial global longitudinal strain (GLS), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and myocardial work efficiency (GWE) were determined by speckle-tracking echocardiography (STE). Results The GLS values in the T2DM patients were significantly lower than those in normal controls (p < 0.001). The GWW in T2DM patients was significantly greater than that in normal controls, while GWI, GCW and GWE was significantly lower (p < 0.001). Receiver operating characteristic (ROC) analysis showed there were no significant different difference between GWW, GWE and GLS in the area under the curves (AUCs). In T2DM patients, fasting plasma glucose was positively correlated with GWW but negatively correlated with GWE, and GLS was negatively correlated with GWI and GCW. Conclusion From the research, we found that global MW as new technique could detect the subclinical LV myocardial dysfunction and confirm that the impaired LV function in T2DM patients with preserved LV systolic function.

Assessment of left ventricular function in patients with type 2 diabetes mellitus by non-invasive myocardial work

“…Wang (8) and Yan (9) have suggested that individuals with T2DM exhibit increased global wasted work (GWW) and decreased global work efficiency (GWE) compared to the general population. However, Wang et al found no statistically significant differences in GWW and GWE between the two groups (10). In the present study, we used a non-invasive myocardial work technique to obtain myocardial work parameters and compared them with conventional ultrasound parameters after excluding potential confounding factors.…”

“…Conversely, GWW reflects the LV myocardial work done to hinder ventricular ejection and relaxation by making myocardial lengthening during systole and shortening during diastole. GWE can be calculated as GCW/(GCW+GWW) ( 10 , 23 ). The Tei index is the ratio of the sum of isovolumic contraction time and isovolumic relaxation time to the ejection time, and it reflects the overall systolic and diastolic function of the LV.…”

“…However, Wang et al. found no statistically significant differences in GWW and GWE between the two groups ( 10 ). In the present study, we used a non-invasive myocardial work technique to obtain myocardial work parameters and compared them with conventional ultrasound parameters after excluding potential confounding factors.…”

“…First, the potential confounding effects of other coexisting conditions, including but not limited to hyperlipidemia and hypertension, on cardiac function injury have not been adequately addressed. Second, conventional ultrasound parameters have not been comprehensively evaluated in comparative studies (8)(9)(10). Finally, the results of some studies are controversial.…”

The Role of Echocardiography in Evaluating Cardiovascular Diseases in Patients with Diabetes Mellitus

“…It was recently discovered that LVGLS can be used to supplement LVEF, particularly in patients with HFpEF [ 3 , 6 , 49 ]. Decreased LVGLS is a marker of myocardial dysfunction that indicates subclinical LV dysfunction before clinical symptoms develop [ 3 , 50 , 51 ]. Furthermore, strain echocardiography can detect early diastolic dysfunction by calculating left atrial strain [ 52 , 53 ].…”