实时三维斑点追踪成像及磁共振成像对2型糖尿病患者心室舒缩功能的评价

Evaluation of real-time 3D-STI and MRI on ventricular systolic and diastolic function of T2DM patients

目的:探究实时三维斑点追踪成像(3D-STI)及磁共振成像(MRI)对2型糖尿病(T2DM)患者心室舒缩功能的评价。方法:选取2022年1月至2023年6月大庆龙南医院收治的100例T2DM患者,依据左心室射血分数(LVEF)水平将其分为≥50%组(62例)和<50%组(38例),比较不同LVEF患者3D-STI和MRI参数的差异,并比较3D-STI参数、MRI参数以及联合数据诊断T2DM患者心功能不全的效能。结果:LVEF<50%组患者的室间隔舒张末期厚度(IVsd)、左前降支(LAd)、左心室后壁舒张末期厚度(LVPWd)、全局面积应变(GAS)、全局纵向应变(GLS)及全局圆周应变(GCS)指标,以及左室收缩期容积(ESV)及右室收缩期容积(EDV)均高于LVEF≥50%组患者;二尖瓣口舒张期血流频谱A峰与E峰速度比值(E/A)、全局径向应变(GRS)、心搏量(SV)、射血分数(EF)及心排血量(CO)均低于LVEF≥50%组患者,差异有统计学意义(t=5.213、4.778、4.936、5.863、4.302、5.057、5.350、5.072、4.636、4.963、5.076、4.898、5.475,P<0.05)。二元logistic回归分析显示,IVsd、LAd、LVPWd、GAS、GLS、GCS、ESV及EDV为T2DM患者心功能不全的危险因素(OR=2.102、1.286、1.605、1.311、1.314、1.324、1.291、1.063,P<0.05),E/A、GRS、SV、EF及CO为T2DM患者心功能不全的保护因素(OR=0.008、0.823、0.813、1.850、0.201,P<0.05)。采用受试者工作特征(ROC)曲线分析获取MRI参数(SV、EF、ESV、EDV、CO)、3D-STI参数(IVsd、LAd、LVPWd、E/A、GRS、GAS、GLS、GCS)诊断T2DM患者心功能不全的ROC曲线下面积(AUC)分别为0.781、0.743、0.800、0.784、0.777、0.793、0.770、0.754、0.745、0.786、0.836、0.766和0.799。将MRI参数和3D-STI参数纳入logistic回归模型,联合数据诊断T2DM患者心功能不全的AUC为0.995,灵敏度为97.4%,特异度为98.4%。结论:MRI和3D-STI参数可评估T2DM患者心室舒缩功能,且联合数据诊断价值更好。

Objective:To explore the evaluation of real-time three-dimensional speckle tracking imaging(3D-STI)and magnetic resonance imaging(MRI)on ventricular systolic and diastolic function of patients with type 2 diabetes mellitus(T2DM).Methods:A total of 100 T2DM patients admitted to Daqing Longnan Hospital from January 2022 to June 2023 were selected,and they were divided into≥50%group(62 patients)and<50%group(38 patients)based on the level of left ventricular ejection fraction(LVEF).The differences of 3D-STI and MRI parameters between different LVEF patients were compared,and the efficiencies of the 3D-STI parameter,MRI parameter and the combined data were also compared in diagnosing the cardiac insufficiency of T2DM patients.Results:The end-diastolic thickness of the interventricular septum(IVsd),left anterior descending branch(LAd),end-diastolic thickness of the posterior wall of the left ventricle(LVPWd),global area strain(GAS),global longitudinal strain(GLS),global circumferential strain(GCS),left ventricular systolic volume(ESV)and right ventricular systolic volume(EDV)in LVEF<50%group were respectively higher than those in LVEF≥50%group.The velocities of peak A and E of mitral valve diastolic blood flow spectrum(E/A),global radial strain(GRS),stroke volume(SV),ejection fraction(EF)and cardiac output(CO)in LVEF<50%group were significantly lower than those in LVEF≥50%group,and the differences were statistically significant(t=5.213,4.778,4.936,5.863,4.302,5.057,5.350,5.072,4.636,4.963,5.076,4.898,5.475,P<0.05),respectively.The binary logistic regression analysis showed that IVsd,LAd,LVPWd,GAS,GLS,GCS,ESV and EDV were risk factors for T2DM patients with cardiac insufficiency(OR=2.102,1.286,1.605,1.311,1.314,1.324,1.291,1.063,P<0.05),respectively,and E/A,GRS,SV,EF and CO were protective factors for T2DM patients with cardiac insufficiency(OR=0.008,0.823,0.813,1.850,0.201,P<0.05).The area under curve(AUC)values of receiver operating characteristic(ROC)curves of MRI parameter(SV,EF,ESV,EDV and CO)and 3D-STI parameters(IVsd,LAd,LVPWd,E/A,GRS,GAS,GLS and GCS)were respectively 0.781,0.743,0.800,0.784,0.777,0.793,0.770,0.754,0.745,0.786,0.836,0.766,and 0.799 in diagnosing cardiac insufficiency of patients with T2DM.The MRI parameters and 3D-STI parameters were included into the Logistic regression model,and the AUC value of the combined data was 0.995 in diagnosing cardiac insufficiency of patients with T2DM,and the sensitivity and specificity of the combined data were respectively 97.4%and 98.4%.Conclusion:MRI parameters and 3D-STI parameters can assess ventricular systolic and diastolic function of T2DM patients,and the combined data has better diagnostic value.