Benchea Laura-Cătălina, Anghel Larisa, Dubei Nicoleta, Zanfirescu Răzvan-Liviu, Bîrgoan Gavril-Silviu, Sascău Radu Andy, Stătescu Cristian
Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700503 Iași, Romania.
Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", 700503 Iași, Romania.
Medicina (Kaunas). 2025 Aug 23;61(9):1516. doi: 10.3390/medicina61091516.
: Type 2 diabetes (T2DM) substantially increases cardiovascular risk; beyond the well-recognized left-ventricular involvement in diabetic cardiomyopathy, emerging data indicate subclinical right-ventricular (RV) dysfunction may also be present. This study aimed to evaluate whether speckle-tracking echocardiography identifies subclinical right-ventricular systolic dysfunction in type 2 diabetes, despite normal conventional indices and preserved global systolic function. : We conducted a cross-sectional, single-center study in accordance with STROBE recommendations, enrolling 77 participants, 36 adults with T2DM, and 41 non-diabetic controls, between December 2024 and July 2025. All participants underwent comprehensive transthoracic echocardiography, including conventional parameters (tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TV S'), right ventricular fractional area change (RVFAC)) and deformation imaging (right ventricular global longitudinal strain (RV GLS), right ventricular free wall longitudinal strain (RVFWS)) using speckle-tracking echocardiography. Biochemical and clinical data, including glycosylated hemoglobin (HbA1c), were recorded. Correlation and ROC curve analyses were performed to explore associations and predictive value. : The mean age was comparable between the two groups (62.08 ± 9.54 years vs. 60.22 ± 13.39 years; = 0.480). While conventional RV parameters did not differ significantly between groups, diabetic patients had significantly lower RV GLS (-13.86 ± 6.07% vs. -18.59 ± 2.27%, < 0.001) and RVFWS (-15.64 ± 4.30% vs. -19.03 ± 3.53%, < 0.001). HbA1c levels correlated positively with RV strain impairment (RVFWS r = 0.41, < 0.001). Both RV GLS and RVFWS were independent predictors of RV dysfunction in logistic regression analysis. ROC analysis showed good diagnostic performance for RV GLS, AUC = 0.84 with an optimal cut-off -17.2% (sensitivity 86.1% and specificity 80.5%) and RVFWS, AUC = 0.76 with cut-off -17.6% (sensitivity 77.8; specificity 80.5%) in identifying early myocardial involvement. : RV systolic dysfunction may occur early in T2DM, even when traditional echocardiographic indices remain within normal limits. Speckle-tracking echocardiography, particularly RV GLS and RVFWS, offers sensitive detection of subclinical myocardial impairment, reinforcing its value in early cardiovascular risk stratification among diabetic patients.
2型糖尿病（T2DM）会显著增加心血管疾病风险；除了糖尿病性心肌病中广为人知的左心室受累外，新出现的数据表明，亚临床右心室（RV）功能障碍可能也存在。本研究旨在评估斑点追踪超声心动图能否识别2型糖尿病患者中的亚临床右心室收缩功能障碍，尽管其传统指标正常且整体收缩功能保留。
我们按照STROBE指南进行了一项横断面单中心研究，在2024年12月至2025年7月期间招募了77名参与者，其中36名成年T2DM患者和41名非糖尿病对照者。所有参与者均接受了全面的经胸超声心动图检查，包括传统参数（三尖瓣环平面收缩期位移（TAPSE）、三尖瓣环收缩期速度（TV S'）、右心室面积变化分数（RVFAC））以及使用斑点追踪超声心动图的形变成像（右心室整体纵向应变（RV GLS）、右心室游离壁纵向应变（RVFWS））。记录了包括糖化血红蛋白（HbA1c）在内的生化和临床数据。进行了相关性分析和ROC曲线分析以探索关联和预测价值。
两组的平均年龄相当（62.08±9.54岁对60.22±13.39岁；P = 0.480）。虽然两组之间传统的右心室参数无显著差异，但糖尿病患者的右心室GLS显著降低（-13.86±6.07%对-18.59±2.27%，P<0.001）以及右心室FWS显著降低（-15.64±4.30%对-19.03±3.53%，P<0.001）。HbA1c水平与右心室应变受损呈正相关（右心室FWS r = 0.41，P<0.001）。在逻辑回归分析中右心室GLS和右心室FWS均是右心室功能障碍的独立预测因素。ROC分析显示右心室GLS具有良好的诊断性能，AUC = 0.84，最佳截断值为-17.2%（敏感性86.1%，特异性80.5%），右心室FWS的AUC = 0.76，截断值为-17.6%（敏感性77.8；特异性80.5%）用于识别早期心肌受累情况。
右心室收缩功能障碍可能在T2DM早期就会出现，即使传统超声心动图指标仍在正常范围内。斑点追踪超声心动图，尤其是右心室GLS和右心室FWS，能够敏感地检测亚临床心肌损伤，强化了其在糖尿病患者早期心血管风险分层中的价值。
