Association of metabolic factors with left ventricular structure and function in type 2 diabetic patients: A 3D speckle tracking imaging study
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摘要: 目的:应用常规超声心动图和三维斑点追踪成像评价2型糖尿病(T2DM)患者的左室结构和功能,探讨代谢因素如何影响左室的结构和功能。方法:150例接受治疗的T2DM患者,按照代谢因素控制的情况分为DM1组(0个代谢因素控制不佳,35例)、DM2组(1~2个代谢因素控制不佳,62例)、DM3组(≥3个代谢因素控制不佳,53例)。另选取40例健康志愿者作为对照组。入组者进行常规超声心动图和三维斑点追踪成像检查,获取常规超声测量值和左室整体纵向应变(GLS)、整体圆周应变(GCS)、整体面积应变(GAS)和整体径向应变(GRS)。结果:与对照组比较,DM1组的e'、E/A减小(均P<0.05),E、E/e'增大(均P<0.05);DM2组的相对室壁厚度(RWT)增加(P<0.05),DM3组的RWT及左室质量指数(LVMI)均明显增加(均P<0.05);DM2组的GLS降低(P<0.05),DM3组的GLS、GCS、GAS、GRS均明显降低(均P<0.05)。多元线性回归分析显示,BMI与左室GLS、GCS、GAS、GRS(β=-0.183、-0.278、-0.258、-0.312,均P<0.05)存在明显的相关性。结论:在T2DM患者中,代谢因素控制良好者仅有左室舒张功能降低;代谢因素控制不佳的负荷增加与左室重构和收缩功能降低有关。Abstract: Objective: To evaluate the left ventricular structure and function in type 2 diabetes mellitus using three-dimensional speckle tracking imaging and to study how metabolic factors impact left ventricular structure and function.Methods: A total of 150 patients with type 2 diabetes with different degrees of metabolic factors were divided into 3 groups: DM1 group(0 poor controlled metabolic factors, n=35), DM2 group(1-2 poor controlled metabolic factors, n=62), and DM3 group(≥3 poor controlled metabolic factors, n=53). Other 40 healthy volunteers served as controls. Conventional echocardiography and three-dimensional speckle tracking imaging were performed. Conventional echocardiographic measurements and left ventricular global longitudinal strain(GLS), global circumferential strain(GCS), global area strain(GAS), and global radial strain(GRS) were obtained.Results: Compared to the control group, e' and E/A were decreased, while E and E/e' were increased in the DM1 group(all P<0.05), the relative wall thickness(RWT) was increased in the DM2 group(P<0.05), the RWT and left ventricular mass index(LVMI) were significantly increased in the DM3 group(all P<0.05), GLS was decreased in the DM2 group(P<0.05), while GLS, GCS, GAS, and GRS were significantly decreased in the DM3 group(all P<0.05). Multivariable linear regression indicated that BMI was independently associated with GLS, GCS, GAS, and GRS(β=-0.183,-0.278,-0.258,-0.312, all P<0.05).Conclusion: In patients with type 2 diabetes, only left ventricular diastolic function impaired in patients with metabolic factors are well controlled. The increasing burden of poor controlled metabolic factors is associated with structural and functional impairments.
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