Peak strain dispersion is a reliable index for evaluating left ventricular systolic function in diabetic patients
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摘要:
目的 应用峰值应变离散度（PSD）对2型糖尿病患者左室收缩功能的早期改变进行探索。 方法 收集本院2型糖尿病患者95例，根据糖化血红蛋白进一步分组，分为血糖控制组（A组，糖化血红蛋白 < 7%，n=45）和血糖未控制组（B组，糖化血红蛋白≥7.0%，n=50），另取健康体检者50例作为对照组。所有参与者均行常规超声心动图检查并取其参数，采集连续3个心动周期的左室心尖二腔、三腔、四腔。存储二维动态图像在后台描记分析，获得左室整体纵向应变及PSD。比较3组之间参数的差异。 结果 A组与对照组间整体纵向应变的差异无统计学意义（P=0.08），B组与对照组相比整体纵向应变减小（P < 0.01）。A组及B组与对照组相比，PSD均明显增高（P < 0.01）。相关性分析显示，左室整体纵向应变与PSD间呈负相关关系，糖化血红蛋白及空腹血糖与左室PSD呈正相关关系（P < 0.01）。 结论 PSD可定量评价2型糖尿病患者早期左室收缩功能的改变，是评定糖尿病患者左室心肌运动的一个早期、可靠的指标。 Abstract:Objective To investigate the early changes of left ventricular systolic function in patients with type 2 diabetes mellitus using peak strain dispersion (PSD). Methods Ninety-five patients with type 2 diabetes mellitus were enrolled. They were divided into two groups based on their HbA1c levels: controlled blood glucose group (group A, HbA1c < 7%, n=45) and uncontrolled blood glucose group (group B, HbA1c≥7.0%, n=50). An additional 50 healthy subjects were selected as control group. Conventional echocardiography was performed, and parameters were obtained. The left ventricular global longitudinal strain and PSD were obtained using two-dimensional dynamic images and tracing analysis. The differences in parameters between the groups were compared. Results There was no significant difference in left ventricular global longitudinal strain between group A and the control group (P=0.08), while left ventricular global longitudinal strain in group B was significantly reduced compared with the control group (P < 0.01). Compared with the control group, PSD was significantly increased in group A and group B (P < 0.01). Correlation analysis revealed that left ventricular global longitudinal strain was negatively correlated with PSD, while glycosylated hemoglobin and fasting blood glucose were positively correlated with PSD (P < 0.01). Conclusion PSD can be used to quantitatively evaluate changes in left ventricular systolic function in patients with type 2 diabetes mellitus. PSD is an early and reliable indicator for evaluating left ventricular myocardial movement in patients with diabetes. -
图 1 A组患者（女，69岁）左室2D-STI图
Figure 1. Left ventricular 2D-STI of group A (female, 69 years old). A: Apical four-chamber view longitudinal strain curve; B: Left ventricular 17-segment bull's eye.
图 2 B组患者（男，57岁）左室2D-STI图
Figure 2. Left ventricular 2D-STI of group B (male, 57 years old). A: Apical four-chamber view longitudinal strain curve; B: Left ventricular 17-segment bull's eye.
图 3 PSD的相关性分析散点图
Figure 3. Correlation analysis scatter plot of PSD.A: Scatter chart of correlation analysis between PSD and LVGLS; B: Scatter diagram of correlation analysis between HbA1c and PSD; C: Scatter plot of correlation analysis between fasting blood glucose and PSD.
图 4 PSD值在观察者内及观察者间的Bland-Altman分析
Figure 4. Bland-Altman analysis of PSD values within and between observers. A: Bland-Altman analysis diagram with PSD values in the observer; B: Bland-Altman diagram of interobserver PSD values.
表 1 各组一般资料比较
Table 1. Comparison of general data of each group (Mean±SD)
Index Control group (n=50) Group A (n=45) Group B (n=50) P Gender (Male/Female, n) 24/26 23/22 26/24 0.92 Age (years) 53.2±2.0 56.0±9.2 51.3±12.5 0.11 Body surface area (m2) 1.65±0.14 1.68±0.16 1.66±0.16 0.56 BMI（kg/m2） 22.60±2.78 23.04±2.85 22.38±2.54 0.49 Systolic pressure (mmHg) 124.68±9.49 125.18±8.39 121.04±9.95 0.12 Heart rate (b/min) 71.28±8.97 72, 69±11.24 73.62±9.04 0.48 Empty abdominal blood sugar (mmol/L) 4.75±0.52 7.13±0.59* 12.05±0.64*# < 0.01 HbA1c (%) N/A 6.05±0.49 9.86±0.68# < 0.01 *P < 0.05 vs control group; #P < 0.05 vs group A. HbA1c: Glycosylated hemoglobin. Group A: Controlled blood glucose group; Group B: Uncontrolled blood glucose group. 1 mmHg=0.133 kPa. 
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表 2 各组常规超声心动图参数比较
Table 2. Comparison of conventional echocardiographic parameters in each group (Mean±SD)
Parameter Control group Group A Group B P IVS（mm） 8.22±1.23 8.09±0.82 8.23±1.17 0.48 LVPWT（mm） 8.38±1.37 7.91±1.24 8.02±1.00 0.14 LVEF（%） 69.48±5.68 66.96±4.11 67.98±5.36 0.06 LVFS（%） 39.14±4.86 37.13±3.63 38.10±4.60 0.09 LAD（mm） 35.20±4.93 35.56±3.60 35.18±4.60 0.90 LVEDD（mm） 45.92±4.37 46.78±3.93 45.02±4.21 0.13 LVMI（g/m2） 71.15±15.25 80.51±16.11* 83.33±16.82* < 0.01 LVEDV（mL） 106.56±19.28 108.84±19.60 105.71±13.94 0.68 Peak E（cm/s） 82.68±18.53 76.09±13.29 71.60±16.94* < 0.01 Peak A（cm/s） 62.80±16.89 63.91±15.23 70.74±14.38* 0.03 E/A 1.38±0.45 1.24±0.31 1.04±0.30* < 0.01 Em（cm/s） 8.39±1.78 7.30±1.23* 6.22±1.46*# < 0.01 Am（cm/s） 8.49±1.64 8.26±0.99 9.25±1.46*# < 0.01 E/Em 10.22±2.93 10.64±2.23 11.81±2.93* 0.01 *P < 0.05 vs control group; #P < 0.05 vs group A. IVS: Thickness of ventricular septum; LVPWT: Left ventricular posterior wall thickness; LVEF: Left ventricular ejection fraction; LVFS: Left indoor diameter shortening rate; LAD: Left atrial diameter; LVEDD: Left ventricular end-diastolic diameter; LVMI: Left ventricular mass index; LVEDV: Left ventricular end-diastolic volume.
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表 3 2型糖尿病患者左室中GLS和PSD参数的损害
Table 3. Damages of GLS and PSD parameters in left ventricle of T2DM patients (Mean±SD)
Parameter Control group Group A Group B P LVGLS（%） 21.43±2.99 20.19±2.37 17.75±2.62*# < 0.01 PSD（ms） 24.53±4.86 35.94±4.56* 47.04±3.52*# < 0.01 *P < 0.05 vs control group; #P < 0.05 vs group A. LVGLS: Overall longitudinal strain of left ventricle; PSD: Peak strain dispersion.
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