Subclinical impairment of left ventricular myocardium function in type 2 diabetes mellitus patients with or without hypertension

doi:10.4239/wjd.v15.i6.1272

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World Journal of Diabetes

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1948-9358

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World J Diabetes. Jun 15, 2024; 15(6): 1272-1279
Published online Jun 15, 2024. doi: 10.4239/wjd.v15.i6.1272

Table 1 Clinical parameters of patients with healthy subjects, type 2 diabetes mellitus patients and type 2 diabetes mellitus patients with hypertension

Clinical parameters	Healthy subjects (n = 101)	T2DM (n = 97)	T2DM + HP (n = 70)	P value
Age, yr	48.06 ± 9.90	49.04 ± 12.80	52.00 ± 11.50	0.068
Male, n (%)	48 (48)	61 (63)	39 (56)	0.094
Hight, cm	165.10 ± 7.50	166.87 ± 9.25	164.66 ± 7.53	0.199
Wight, kg	64.14 ± 10.58	72.50 ± 15.34¹	72.23 ± 13.80¹	< 0.001
BMI, kg/m²	23.44 ± 2.84	25.85 ± 3.90¹	26.51 ± 4.02¹	< 0.001
BSA, m²	1.68 ± 0.17	1.79 ± 0.24¹	1.78 ± 0.21¹	< 0.001
SBP, mmHg	123.26 ± 10.82	127.65 ± 14.70¹	137.07 ± 17.34¹^,²	< 0.001
DBP, mmHg	77.85 ± 7.65	79.25 ± 10.59	86.64 ± 10.20¹^,²	< 0.001
HR, bpm	69.85 ± 9.76	75.22 ± 9.60¹	79.10 ± 12.72¹^,²	<0.001
FPG, mmol/L	4.95 (4.59, 5.25)	10.53 (7.87, 14.07)¹	8.91 (7.57, 10.97)¹	< 0.001
HbA1c, %	5.45 ± 0.38	9.73 ± 2.27¹	8.85 ± 2.49¹^,²	< 0.001
TC, mmol/L	4.54 ± 0.85	4.37 ± 0.90	4.70 ± 1.14	0.102
TG, mmol/L	1.21 (0.88,1.78)	1.53 (0.97, 2.15)¹	2.00 (1.38, 2.83)¹^,²	< 0.001
HDL-C, mmol/L	1.27 ± 0.30	1.09 ± 0.29¹	1.04 ± 0.28¹	< 0.001
LDL-C, mmol/L	2.68 ± 0.70	2.65 ± 0.79	2.81 ± 0.99	0.556
LPA, g/L	0.17 (0.11, 0.28)	0.14 (0.06, 0.24)	0.14 (0.08, 0.25)	0.231
BUN, mmol/L	4.75 (3.60, 5.70)	5.50 (4.60, 6.30)¹	5.50 (4.50, 7.40)¹	0.001
SCR, μmol/L	61.00 (55.00, 76.00)	59.00 (49.30, 71.10)	64.00 (54.00, 87.00)²	0.030
Medication, n (%)
ACEI/ARB	-	-	32 (46)
Calcium channel blocker	-	-	37 (53)
β-blocker	-	-	4 (6)
SGLT-2 inhibitor	-	18 (19)	28 (40)
Metformin	-	59 (61)	38 (54)
Insulin	-	55 (57)	35 (50)

¹Significantly different (P < 0.05) between type 2 diabetes mellitus (T2DM) or T2DM + hypertension (HP) patients and healthy subjects.

²Significantly different (P < 0.05) between T2DM + HP patients and T2DM patients.

BMI: Body mass index; BSA: Body surface area; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; HR: Heart rate; FPG: Fasting plasma glucose; HbA1c: Glycated haemoglobin; TC: Total cholesterol; TG: Triglyceride; HDL-C: High-density lipoprotein; LDL-C: Low-density lipoprotein; BUN: Blood urea nitrogen; SCR: Serum creatinine.

Table 2 Echocardiographic parameters among healthy subjects, type 2 diabetes mellitus patients, and type 2 diabetes mellitus + hypertension patients

Echocardiographic parameters	Healthy subjects (n = 101)	T2DM (n = 97)	T2DM + HP (n = 70)	P value
LAd, mm	34.00 ± 2.97	35.03 ± 3.04¹	36.69 ± 3.91¹^,²	< 0.001
LAV index, mL/m²	29.17 ± 7.19	32.20 ± 6.80¹	30.92 ± 8.10	0.016
IVSd, mm	9.21 ± 0.79	9.01 ± 0.98	9.71 ± 0.95¹^,²	< 0.001
LVPWd, mm	9.01 ± 0.80	8.81 ± 0.93	9.53 ± 1.00¹^,²	< 0.001
LVDd, mm	46.39 ± 2.95	45.85 ± 3.49	46.89 ± 3.40	0.124
LVEDV, mL	76.61 ± 15.17	69.57 ± 20.54¹	76.77 ± 22.26²	0.018
LVESV, mL	27.19 ± 6.65	25.01 ± 8.14	27.93 ± 8.76²	0.037
LVEF, %	64.56 ± 3.74	64.35 ± 2.89	63.54 ± 2.71	0.080
MAPSE, mm	14.47 ± 1.44	14.23 ± 1.75	13.42 ± 2.07¹^,²	0.002
E, m/s	0.83 ± 0.13	0.78 ± 0.14¹	0.78 ± 0.16¹	0.008
A, m/s	0.68 ± 0.16	0.69 ± 0.15	0.82 ± 0.18¹^,²	< 0.001
E/A	1.27 ± 0.29	1.16 ± 0.29¹	1.00 ± 0.36¹^,²	< 0.001
e’, m/s	0.11 ± 0.02	0.10 ± 0.02	0.10 ± 0.11	0.117
E/e’	7.62 ± 1.54	8.30 ± 1.63¹	9.00 ± 2.47¹^,²	< 0.001

¹Significantly different (P < 0.05) between type 2 diabetes mellitus (T2DM) or T2DM + hypertension (HP) patients and healthy subjects.

²Significantly different (P < 0.05) between T2DM + HP patients and T2DM patients.

LAd: Left atrial diameter; LAV index: Left atrial volume index; IVSd: Interventricular septal wall thickness in the end-diastolic period; LVPWd: Left ventricular posterior wall thickness in the end-diastolic period; LVDd: Left ventricular diameter in the end-diastolic period; LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume; LVEF: Left ventricular ejection fraction; MAPSE: Mitral annular plane systolic excursion; E: Peak velocity during early diastole of anterior mitral leaflet; A: Peak velocity during late diastole of anterior mitral leaflet; e’: Peak early diastolic annular velocities using TDI by averaging the values at the septum and lateral positions.

Table 3 Layer-specific global longitudinal strain and peak strain dispersion among healthy subjects, type 2 diabetes mellitus patients, and type 2 diabetes mellitus + hypertension patients

	Healthy subjects (n = 101)	T2DM (n = 97)	T2DM + HP (n = 70)	P₁ value	P_trend value
GLSepi, %	-18.66 ± 1.58	-17.33 ± 1.93¹	-16.74 ± 1.93¹^,²	< 0.001	< 0.001
GLSmid, %	-21.58 ± 1.84³	-19.87 ± 2.21¹^,³	-19.28 ± 2.16¹^,³	< 0.001	< 0.001
GLSendo, %	-25.03 ± 2.24³^,⁴	-22.97 ± 2.56¹^,³^,⁴	-22.48 ± 2.50¹^,³^,⁴	< 0.001	< 0.001
PSD, msec	28.79 ± 7.25	34.92 ± 11.19¹	39.23 ± 11.47¹^,²	< 0.001	< 0.001
P2 value	< 0.001	< 0.001	< 0.001

¹Significantly different (P < 0.05) between type 2 diabetes mellitus (T2DM) or T2DM + hypertension (HP) patients and healthy subjects.

²Significantly different (P < 0.05) between T2DM + HP patients and T2DM patients.

³Significant difference (P < 0.05) of GLSmid and GLSendo vs GLSepi in healthy subjects, T2DM patients and T2DM + HP patients.

⁴Significant difference (P < 0.05) of GLSendo vs GLSmid in healthy subjects, T2DM patients and T2DM + HP patients.

P1: Difference between healthy subjects and T2DM and T2DM + HP patients; P2: Difference between GLSepi, GLSmid and GLSendo in healthy subjects, T2DM patients or T2DM + HP patients. GLS: Global longitudinal strain; GLSEpi: Global longitudinal strain of the epimyocardium; GLSMid: Global longitudinal strain of the middle myocardium; GLSEndo: Global longitudinal strain of the endocardium; PSD: Peak strain dispersion.

Table 4 Intraclass correlation coefficients for intra- and interobserver variability for layer-specific global longitudinal strain and peak strain dispersion

Variable	Interobserver variability		Intraobserver variability
Variable	ICC	95%CI	ICC	95%CI
GLSendo	0.959	0.896-0.984	0.964	0.909-0.986
GLSmid	0.965	0.911-0.986	0.973	0.933-0.989
GLSepi	0.959	0.898-0.984	0.975	0.936-0.990
PSD	0.955	0.887-0.982	0.976	0.939-0.990

GLS: Global longitudinal strain; PSD: Peak strain dispersion; ICC: Intraclass correlation coefficient; 95%CI: 95% confidence interval.

Citation: Chen ZG, Li GA, Huang J, Fan L. Subclinical impairment of left ventricular myocardium function in type 2 diabetes mellitus patients with or without hypertension. World J Diabetes 2024; 15(6): 1272-1279
URL: https://www.wjgnet.com/1948-9358/full/v15/i6/1272.htm
DOI: https://dx.doi.org/10.4239/wjd.v15.i6.1272