Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jun 15, 2024; 15(6): 1280-1290
Published online Jun 15, 2024. doi: 10.4239/wjd.v15.i6.1280
Evaluation of left ventricular systolic function in type 2 diabetes mellitus patients with and without peripheral vascular disease
Guang-An Li, Jun Huang, Li Fan
Guang-An Li, Jun Huang, Li Fan, Department of Echocardiography, The Affiliated Changzhou Second People’s Hospital with Nanjing Medical University, Changzhou 213000, Jiangsu Province, China
Author contributions: Li GA and Huang J designed the study and carried out the study, data collection and analysis; Li GA wrote the manuscript; Huang J revised the manuscript; Huang J and Fan L collected the type 2 diabetes mellitus patients and normal controls; and Fan L performed the statistical analysis.
Supported by The Science and Technology Project of Changzhou Health Commission, No. ZD202342.
Institutional review board statement: This research was approved by the Human Research and Ethics Committee of the Affiliated Changzhou Second People’s Hospital of Nanjing Medical University, No. 2016-YLJSE009.
Informed consent statement: All the normal controls and type 2 diabetes mellitus patients underwent echocardiography. When they underwent this examination, we told them that we would like to do research on their cardiac function, and if they provided consent, we analysed their data; if they did not consent, we did not analyse their data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data collected during the study are available from the corresponding author by request: Huang J, E-mail: 305669112@qq.com.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Huang, MD, PhD, Chief Doctor, Doctor, Postdoc, Teacher, Department of Echocardiography, The Affiliated Changzhou Second People’s Hospital with Nanjing Medical University, No. 68 Gehu Road, Changzhou 213000, Jiangsu Province, China. 305669112@qq.com
Received: January 20, 2024
Revised: February 29, 2024
Accepted: April 26, 2024
Published online: June 15, 2024
Processing time: 143 Days and 8.5 Hours
Abstract
BACKGROUND

Peripheral vascular disease (PVD) is a common complication of type 2 diabetes mellitus (T2DM). Patients with T2DM have twice the risk of PVD as nondiabetic patients.

AIM

To evaluate left ventricular (LV) systolic function by layer-specific global longitudinal strain (GLS) and peak strain dispersion (PSD) in T2DM patients with and without PVD.

METHODS

Sixty-five T2DM patients without PVD, 57 T2DM patients with PVD and 63 normal controls were enrolled in the study. Layer-specific GLS [GLS of the epimyocardium (GLSepi), GLS of the middle myocardium (GLSmid) and GLS of the endocardium (GLSendo)] and PSD were calculated. Receiver operating characteristic (ROC) analysis was performed to calculate the sensitivity and specificity of LV systolic dysfunction in T2DM patients with PVD. We calculated Pearson’s correlation coefficients between biochemical data, echocardiographic characteristics, and layer-specific GLS and PSD.

RESULTS

There were significant differences in GLSepi, GLSmid and GLSendo between normal controls, T2DM patients without PVD and T2DM patients with PVD (P < 0.001). Trend tests revealed a ranking of normal controls > T2DM patients without PVD > T2DM patients with PVD in the absolute value of GLS (P < 0.001). PSD differed significantly between the three groups, and the trend ranking was as follows: normal controls < T2DM patients without PVD < T2DM patients with PVD (P < 0.001). ROC analysis revealed that the combination of layer-specific GLS and PSD had high diagnostic efficiency for detecting LV systolic dysfunction in T2DM patients with PVD. Low-density lipoprotein cholesterol was positively correlated with GLSepi, GLSmid and PSD (P < 0.05), while LV ejection fraction was negatively correlated with GLSepi, GLSmid and GLSendo in T2DM patients with PVD (P < 0.01).

CONCLUSION

PVD may aggravate the deterioration of LV systolic dysfunction in T2DM patients. Layer-specific GLS and PSD can be used to detect LV systolic dysfunction accurately and conveniently in T2DM patients with or without PVD.

Keywords: Type 2 diabetes mellitus; Peripheral vascular disease; Speckle tracking echocardiography; Global longitudinal strain; Peak strain dispersion

Core Tip: Left ventricular (LV) systolic function is impaired in type 2 diabetes mellitus (T2DM) patients, especially those with peripheral vascular disease (PVD). Layer-specific global longitudinal strain (GLS) and PSD can be used to detect LV systolic dysfunction flexibly, accurately and conveniently. The level of low-density lipoprotein cholesterol was positively correlated with global longitudinal strain of the epimyocardium, global longitudinal strain of the middle myocardium and PSD. PVD may aggravate the LV systolic dysfunction in T2DM patients. Layer-specific GLS and PSD can be used to detect LV systolic dysfunction flexibly, accurately and conveniently in T2DM patients with or without PVD.