Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, People's Republic of China.
Heart Center, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei, People's Republic of China.
BMC Cardiovasc Disord. 2023 May 22;23(1):266. doi: 10.1186/s12872-023-03239-2.
Diabetic cardiomyopathy results in cardiac structural and functional abnormalities. Previous studies have demonstrated that inhibiting the RhoA/ROCK signalling pathway increases the injury resistance of cardiomyocytes. The early detection of cardiac structural and functional alterations may facilitate an improved understanding of the pathophysiologic progress and guide therapy. This study aimed to identify the optimal diagnostic measures for the subtle early alterations of cardiac dysfunction in type 2 diabetes mellitus (T2DM) rats.
Twenty-four rat models were divided into four groups and received treatments for 4 weeks: the CON group (control rats), the DM group (T2DM rats), the DMF group (T2DM rats receiving fasudil) and the CONF group (control rats receiving fasudil) group. Left ventricular (LV) structure was quantified by histological staining and transmission electron microscopy. LV function and myocardial deformation were assessed by high-frequency echocardiography.
Treatment with fasudil, a ROCK inhibitor, significantly protected against diabetes-induced myocardial hypertrophy, fibrosis and mitochondrial dysfunction. Impaired LV performance was found in T2DM rats, as evidenced by significant reductions in the ejection fraction (EF), fractional shortening (FS) and the mitral valve (MV) E/A ratio (which decreased 26%, 34% and 20%, respectively). Fasudil failed to improve the conventional ultrasonic parameters in T2DM rats, but the myocardial deformation measured by speckle-tracking echocardiography (STE) were significantly improved (global circumferential strain, GCS: P = 0.003; GCS rate, GCSR: P = 0.021). When receiver operating characteristic (ROC) curves were used in combination with linear regression analysis, STE parameters were found to be characterized by both optimal prediction of cardiac damage [AUC (95% CI): fractional area change, FAC: 0.927 (0.744, 0.993); GCS: 0.819 (0.610, 0.945); GCSR: 0.899 (0.707, 0.984)] and stronger correlations with cardiac fibrosis (FAC: r = -0.825; GCS: r = 0.772; GCSR: r = 0.829) than conventional parameters.
The results suggest that STE parameters are more sensitive and specific than conventional parameters in predicting the subtle cardiac functional changes that occur in the early stage, providing new insight into the management of diabetic cardiomyopathy.
糖尿病性心肌病导致心脏结构和功能异常。先前的研究表明，抑制 RhoA/ROCK 信号通路可提高心肌细胞的损伤抗性。早期检测心脏结构和功能改变可能有助于更好地了解病理生理进展并指导治疗。本研究旨在确定用于检测 2 型糖尿病 (T2DM) 大鼠心脏功能障碍早期细微改变的最佳诊断措施。
将 24 只大鼠模型分为 4 组，分别接受 4 周的治疗：CON 组（对照组大鼠）、DM 组（T2DM 大鼠）、DMF 组（T2DM 大鼠给予法舒地尔）和 CONF 组（对照组大鼠给予法舒地尔）。通过组织学染色和透射电子显微镜定量评估左心室 (LV) 结构。通过高频超声心动图评估 LV 功能和心肌变形。
使用 ROCK 抑制剂法舒地尔治疗可显著预防糖尿病引起的心肌肥大、纤维化和线粒体功能障碍。T2DM 大鼠的 LV 功能受损，射血分数 (EF)、缩短分数 (FS) 和二尖瓣 (MV) E/A 比值显著降低（分别降低 26%、34%和 20%）。法舒地尔未能改善 T2DM 大鼠的常规超声参数，但斑点追踪超声心动图 (STE) 测量的心肌变形明显改善（整体圆周应变，GCS：P=0.003；GCS 率，GCSR：P=0.021）。当使用受试者工作特征 (ROC) 曲线结合线性回归分析时，发现 STE 参数具有最佳的心脏损伤预测能力 [曲线下面积 (95%CI)：面积分数变化，FAC：0.927（0.744，0.993）；GCS：0.819（0.610，0.945）；GCSR：0.899（0.707，0.984）]，并且与心脏纤维化的相关性更强（FAC：r=-0.825；GCS：r=0.772；GCSR：r=0.829），优于常规参数。
结果表明，STE 参数在预测早期细微心脏功能变化方面比常规参数更敏感和特异，为糖尿病性心肌病的治疗提供了新的思路。
