Department of Ultrasound, Second Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China.
Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China.
Echocardiography. 2023 Aug;40(8):831-840. doi: 10.1111/echo.15650. Epub 2023 Jul 14.
Type 2 diabetes mellitus is a metabolic disease that affects multiple target organs. Current data on right ventricular damage in type 2 diabetes, especially in prediabetes, are limited. Due to the anatomical characteristics of the right ventricle, the assessment of the right ventricle by conventional echocardiography is difficult, whereas the ultrasound two-dimensional speckle tracking echocardiography can provide information on myocardial systolic function by tracking the motion information of myocardial speckles, which can sensitively reflect myocardial mechanical changes.
To assess the effect of prediabetes and diabetes with preserved left ventricular ejection fraction on right ventricular myocardial systolic function and to identify independent risk factors affecting right ventricular systolic function.
A total of 49 normoglycaemic (NG) healthy individuals, 43 prediabetics (PDM), and 52 type 2 diabetics (T2DM) were recruited. All study subjects underwent conventional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE).
The right ventricular global longitudinal strain (RVGLS) (20.80 ± 1.96% vs. 18.99 ± 3.20% vs. 16.85 ± 4.01%), left ventricular global longitudinal strain (LVGLS), and interventricular septal longitudinal strain (IVS-LS) (17.28 ± 2. 35% vs. 16.14 ± 3.22% vs. 15.53 ± 3.33%) gradually decreased from the controls, through patients with prediabetes, to those with diabetes (p < .001). Right ventricular free wall strain (RVFW-LS) was higher in the control group (25.63 ± 4.58% vs. 22.83 ± 4.83% vs. 20.79 ± 4.92%) than in the other two groups with a statistically significant difference (p < .001), while RVFW-LS was not statistically different between the prediabetic and diabetic groups. Multivariate regression analysis showed that HbA1c (β = -.626, p < .001), IVS-LS (β = .417, p < .001), and left ventricular end-diastolic diameter (LVEDd) (β = .191, p = .011) were independently correlated with RVGLS.
Two-dimensional speckle tracking echocardiography can sensitively detect subtle changes in the early impairment of right ventricular systolic function in patients with abnormal glucose metabolism. Type 2 diabetes is the common mechanism causing impaired myocardial mechanics in the right and left ventricles. The reduced global systolic longitudinal strain of the right ventricle was associated with reduced global septal longitudinal strain and left ventricular remodeling. HbA1c is an independent predictor of the global longitudinal strain of the right ventricle, and controlling blood glucose levels may be expected to improve the extent of myocardial damage.
2 型糖尿病是一种影响多个靶器官的代谢疾病。目前关于 2 型糖尿病，特别是糖尿病前期的右心室损伤的数据有限。由于右心室的解剖学特点，常规超声心动图评估右心室较为困难，而二维斑点追踪超声心动图可以通过追踪心肌斑点的运动信息来提供心肌收缩功能的信息，能够敏感地反映心肌力学变化。
评估糖尿病前期和伴有左心室射血分数保留的 2 型糖尿病对右心室心肌收缩功能的影响，并确定影响右心室收缩功能的独立危险因素。
共纳入 49 名血糖正常（NG）的健康个体、43 名糖尿病前期患者（PDM）和 52 名 2 型糖尿病患者（T2DM）。所有研究对象均接受常规超声心动图和二维斑点追踪超声心动图（2D-STE）检查。
右心室整体纵向应变（RVGLS）（20.80±1.96%比 18.99±3.20%比 16.85±4.01%）、左心室整体纵向应变（LVGLS）和室间隔纵向应变（IVS-LS）（17.28±2.35%比 16.14±3.22%比 15.53±3.33%）逐渐从对照组，经过糖尿病前期患者，到糖尿病患者降低（p<0.001）。与其他两组相比，对照组的右心室游离壁应变（RVFW-LS）较高（25.63±4.58%比 22.83±4.83%比 20.79±4.92%），差异具有统计学意义（p<0.001），而糖尿病前期和糖尿病组之间的 RVFW-LS 无统计学差异。多变量回归分析显示，HbA1c（β=-.626，p<0.001）、IVS-LS（β=0.417，p<0.001）和左心室舒张末期直径（LVEDd）（β=0.191，p=0.011）与 RVGLS 独立相关。
二维斑点追踪超声心动图能够敏感地检测到异常葡萄糖代谢患者右心室收缩功能早期受损的细微变化。2 型糖尿病是导致左右心室心肌力学受损的共同机制。右心室整体收缩纵向应变降低与整体室间隔纵向应变降低和左心室重构有关。HbA1c 是右心室整体纵向应变的独立预测因子，控制血糖水平有望改善心肌损伤程度。
