斑点追踪成像评价2型糖尿病合并高血压患者多心腔应变的初步研究

Speckle tracking imaging for reviewing multichamber strain in patients with type 2 diabetes mellitus complicated by hypertension:a preliminary study

目的应用斑点追踪成像(STI)技术评估2型糖尿病(T2DM)患者的左心房、左心室和右心室心肌应变,寻找T2DM合并高血压患者心肌功能障碍的早期诊断指标。方法选取2021年1月至2022年10月于石家庄市第二医院治疗的100例血糖控制不佳的无症状T2DM患者为研究对象,根据是否合并高血压病,将其分为单纯T2DM组(T2DM组,n=54)和T2DM合并高血压病组(T2DM+HT组,n=46);另选健康志愿者作为对照组(对照组,n=40)。所有入组者进行常规超声心动图和STI检查,测量常规超声心动图及左室整体纵向应变(LVGLS)、圆周应变(LVGCS)、面积应变(LVGAS)、径向应变(LVGRS)及左房整体纵向应变(LAGLS)和右室游离壁纵向应变(RVFWSL)数据。比较三组间观察指标的差异。结果与对照组比较,T2DM组和T2DM+HT组的LVGLS、LAGLS、RVFWSL均减低(P<0.05)。三组间LVGCS、LVGAS、LVGRS无明显差异(P>0.05)。与T2DM组比较,T2DM+HT组的LAGLS明显减低(P<0.05),但LVGLS、RVFWSL无明显差异(P>0.05)。结论T2DM患者的左心房和双心室应变均受损,T2DM合并高血压病患者左心房应变受损比双心室更早出现,左房整体纵向应变或可作为预测此类人群早期心脏功能改变的潜在指标。

Objective To review left atrial,left ventricular and right ventricular myocardial strains by applying speckle tracking imaging(STI),and find early diagnostic indexes of myocardial dysfunction in patients with(T2DM)and hypertension.Methods Asymptomatic T2DM patients with poor blood glucose control(n=100)were chosen from the Second Hospital of Shijiazhuang City from Jan.2021 to Oct.2022.All patients were divided,according to whether they were complicated by hypertension(HT)or not,into T2DM group(n=54)and T2DM+HT group(n=46).Meanwhile healthy volunteers(n=40)were chosen into control group.All groups were given examinations of routine echocardiogram and STI,and data of echocardiogram,left ventricular global longitudinal strain(LVGLS),left ventricular global circumferential strain(LVGCS),left ventricular global area strain(LVGAS),left ventricular global radial strain(LVGRS),left atrial global longitudinal strain(LAGLS)and right ventricular free wall longitudinal strain(RVFWSL)were detected.The differences in all indexes were observed and compared in 3 groups.Results LVGLS,LAGLS and RVFWSL decreased in T2DM+HT group and T2DM group compared with control group(all P<0.05).LVGCS,LVGAS and LVGRS had no significant difference among 3 groups(all P>0.05).LAGLS decreased significantly in T2DM+HT group compared with T2DM group(P<0.05),while LVGLS and RVFWSL had no significant difference between 2 groups(P>0.05).Conclusion Left atrial and biventricular strains are impaired in T2DM patients.Left atrial strain is impaired even earlier than biventricular strain in T2DM patients complicated by HT.Left atrial global longitudinal strain may be a potential index for predicting early changes of heart function in T2DM with hypertension.