Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Department of Radiology, West China Second Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, Sichuan, China.
Cardiovasc Diabetol. 2024 Aug 8;23(1):294. doi: 10.1186/s12933-024-02372-2.
Patients with concomitant type 2 diabetes mellitus (T2DM) and aortic regurgitation (AR) can present with right ventricular (RV) dysfunction. The current study aimed to evaluate the impact of AR on RV impairment and the importance of ventricular interdependence using cardiac magnetic resonance feature tracking (CMR‑FT) in patients with T2DM.
This study included 229 patients with T2DM (AR-), 88 patients with T2DM (AR+), and 122 healthy controls. The biventricular global radial strain (GRS), global circumferential strain (GCS), and global longitudinal peak strain (GLS) were calculated with CMR‑FT and compared among the healthy control, T2DM (AR-), and T2DM (AR+) groups. The RV regional strains at the basal, mid, and apical cavities between the T2DM (AR+) group and subgroups with different AR degrees were compared. Backward stepwise multivariate linear regression analyses were performed to determine the effects of AR and left ventricular (LV) strains on RV strains.
The RV GLS, LV GRS, LV GCS, LV GLS, interventricular septal (IVS) GRS and IVS GCS were decreased gradually from the controls through the T2DM (AR-) group to the T2DM (AR+) group. The IVS GLS of the T2DM (AR-) and T2DM (AR+) groups was lower than that of the control group. AR was independently associated with LV GRS, LV GCS, LV GLS, RV GCS, and RV GLS. If AR and LV GLSs were included in the regression analyses, AR and LV GLS were independently associated with RV GLS.
AR can exacerbate RV dysfunction in patients with T2DM, which may be associated with the superimposed strain injury of the left ventricle and interventricular septum. The RV longitudinal and circumferential strains are important indicators of cardiac injury in T2DM and AR. The unfavorable LV-RV interdependence supports that while focusing on improving LV function, RV dysfunction should be monitored and treated in order to slow the progression of the disease and the onset of adverse outcomes.
患有 2 型糖尿病（T2DM）和主动脉瓣反流（AR）的患者可能会出现右心室（RV）功能障碍。本研究旨在评估 AR 对 T2DM 患者 RV 损伤的影响以及心脏磁共振特征追踪（CMR-FT）在评估心室相互依赖性方面的重要性。
本研究纳入了 229 例 T2DM（AR-）患者、88 例 T2DM（AR+）患者和 122 例健康对照者。采用 CMR-FT 计算双心室整体径向应变（GRS）、整体周向应变（GCS）和整体纵向峰值应变（GLS），并比较健康对照组、T2DM（AR-）组和 T2DM（AR+）组间差异。比较 T2DM（AR+）组与不同 AR 程度亚组之间 RV 基底、中间和心尖腔的 RV 节段应变。采用逐步多元线性回归分析确定 AR 和 LV 应变对 RV 应变的影响。
RVGLS、LVGRS、LVGCS、LVGLS、室间隔（IVS）GRS 和 IVS GCS 从对照组经 T2DM（AR-）组逐渐降低至 T2DM（AR+）组。T2DM（AR-）和 T2DM（AR+）组的 IVS GLS 均低于对照组。AR 与 LVGRS、LVGCS、LVGLS、RVGCS 和 RVGLS 独立相关。如果将 AR 和 LVGLS 纳入回归分析，AR 和 LVGLS 与 RVGLS 独立相关。
AR 可加重 T2DM 患者的 RV 功能障碍，这可能与左心室和室间隔的叠加应变损伤有关。RV 纵向和周向应变是 T2DM 和 AR 心脏损伤的重要指标。不良的 LV-RV 相互依赖性表明，在关注改善 LV 功能的同时，应监测和治疗 RV 功能障碍，以减缓疾病进展和不良结局的发生。
