https://orcid.org/0000-0002-6401-7050
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Abstract
Background
Diabetic cardiomyopathy (DCM) will gradually progress to heart failure without intervention. The timely identification of left ventricular diastolic dysfunction (LVDD) in the early stage and active intervention helps delay the onset of heart failure. Although myocardial contrast echocardiography (MCE) allows an accurate evaluation of myocardial perfusion (MP), the characteristics of MP in early-stage or even sub-clinical LVDD are still unclear.
Objective
This study aims to reveal the characteristics of MP in asymptomatic and normotensive patients with type 2 diabetes mellitus (T2DM) using MCE and investigate its association with LVDD development.
Methods
A total of 327 T2DM patients were retrospectively analyzed. Patients diagnosed with LVDD were included in the LVDD+ group (n = 76), and those with normal left ventricular diastolic function were included in the LVDD– group (n = 251). The clinical characteristics, general echocardiographic findings, and MCE parameters were compared between the two groups. The accuracy of MCE parameters in the diagnosis of LVDD and their correlations with characteristics of T2DM were evaluated.
Results
In the LVDD+ group, the A×β (derived from the replenishment curve of MCE, presenting myocardial blood flow) was significantly lower, and the HbA1c and diabetes duration were significantly higher compared to the LVDD– group (all P < 0.05). The decrease of A×β helped warn the occurrence of LVDD although it was not suitable for the independent diagnosis of LVDD (AUC = 0.745). A×β was negatively correlated with diabetes duration and HbA1c (r = −0.350 and −0.226, both P < 0.001).
Conclusion
MCE was feasible for detecting MP abnormalities in asymptomatic T2DM patients. Although the A×β values of T2DM patients with subclinical LVDD were better than those with diagnosed LVDD, it impaired with the increase of HbA1c and diabetes duration. It suggested that MCE might be useful for monitoring glycemic control in T2DM patients with DCM.
Data Sharing Statement
The data during the current study are available from the corresponding author on reasonable request.
Ethical Approval
Ethical approval for the study was obtained from the institutional review board of Shuguang Hospital affiliated Shanghai University of TCM (2020-901-110-01).
Informed Consent
Informed consents were waived for this retrospective study because patients’ consent to review their medical records were not required by the institutional review board.
Confidentiality Statement
Information relating to a patient’s health-care history, diagnosis, condition, treatment, or evaluation is considered individually identifiable health information. Confidentiality of this health information is maintained at all times, and may only be disclosed with the express written consent of the patient.
Author Contributions
Yi Liu and Jing Ma contributed equally in this study and are co-first authors. Study design: Yi Liu, Jing Ma, Jia Guo, and Hao Lu. Data collection and analysis: Yi Liu, Jing Ma, Yan Zhang, and Yilei Chen. Supervision: Yi Liu, Jia Guo, and Hao Lu. Statistics: Yi Liu, Jing Ma, Yan Zhang, and Yilei Chen. Manuscript writing: Yi Liu, Jing Ma, Yan Zhang, and Yilei Chen. Manuscript revision: Yi Liu, Jing Ma, Jia Guo, and Hao Lu. Approval of the manuscript: all authors. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
The authors declare that they have no conflicts of interest.