Introduction
Methods
Study population
Conventional echocardiography
Myocardial work
Clinical parameters
Statistical analysis
Results
Study population
Clinical parameters | Normal controls (n = 70) | T2DM (n = 60) | T2DM with dyslipidemia (n = 60) | p value |
---|---|---|---|---|
Age, year | 48.53 ± 9.68 | 48.58 ± 11.69 | 52.86 ± 13.13 | 0.074 |
Male, n (%) | 31 (44%) | 36 (60%) | 35 (58%) | 0.137 |
BMI, kg/m2 | 24.00 ± 3.31 | 25.98 ± 3.52* | 26.63 ± 4.02* | < 0.001 |
BSA, m2 | 1.69 ± 0.20 | 1.79 ± 0.21* | 1.80 ± 0.21* | 0.005 |
SBP, mmHg | 126.17 ± 9.48 | 124.98 ± 11.97 | 135.41 ± 16.38*# | < 0.001 |
DBP, mmHg | 80.03 ± 7.28 | 79.17 ± 9.56 | 85.64 ± 9.97*# | < 0.001 |
HbA1c, % | 5.46 ± 0.38 | 9.78 ± 2.07* | 8.62 ± 2.08*# | < 0.001 |
TC, mmol/L | 4.56 ± 0.89 | 4.36 ± 0.91 | 4.57 ± 1.03 | 0.237 |
TG, mmol/L | 1.36 (1.22,1.78) | 1.78 (1.61,2.25)* | 1.94 (1.93,2.75)* | < 0.001 |
HDL-C, mmol/L | 1.28 ± 0.33 | 1.07 ± 0.26* | 1.00 ± 0.26* | < 0.001 |
LDL-C, mmol/L | 2.67 ± 0.75 | 2.69 ± 0.74 | 2.76 ± 0.89 | 0.448 |
FPG, mmol/L | 4.95 (4.82, 5.14) | 10.68 (10.58, 13.36) * | 9.10 (9.62, 12.96)* | < 0.001 |
BUN, mmol/L | 4.70 (4.23, 5.32) | 5.45 (5.02, 5.89) | 5.50 (5.60, 7.24)* | 0.008 |
SCR, μmol/L | 61.80 (60.35, 70.58) | 58.05 (54.90, 63.91) | 60.55 (61.05, 91.35)# | 0.026 |
Medication | ||||
ACEI/ARB, n (%) | – | – | 24 (40) | |
Calcium channel blocker, n (%) | – | – | 29 (48.3) | |
B-blocker, n (%) | – | – | 4 (6.7) | |
Diuretic, n (%) | – | – | 6 (10) | |
SGLT-2 inhibitor, n (%) | – | 8 (13.3) | 24 (60) | |
Metformin, n (%) | – | 36 (60) | 32 (53.3) | |
Insulin, n (%) | – | 34 (56.7) | 34 (56.7) |
Conventional echocardiographic parameters
Echocardiographic parameters | Normal controls (n = 70) | T2DM (n = 60) | T2DM with HT (n = 60) | p value |
---|---|---|---|---|
LA diameter, mm | 34.30 ± 2.76 | 35.33 ± 2.70 | 36.33 ± 3.40*# | 0.011 |
LAV index, ml/m2 | 30.88 ± 7.58 | 29.63 ± 6.40 | 30.52 ± 7.65 | 0.608 |
IVS diameter, mm | 9.23 ± 0.82 | 8.99 ± 0.95 | 9.76 ± 0.83*# | < 0.001 |
PW diameter, mm | 8.97 ± 0.82 | 8.64 ± 0.89 | 9.50 ± 1.06*# | < 0.001 |
LV diameter, mm | 45.75 ± 2.74 | 46.46 ± 3.70 | 46.66 ± 2.99 | 0.669 |
LVEDV index, ml/m2 | 49.70 ± 9.17 | 44.77 ± 7.90* | 43.35 ± 9.69* | < 0.001 |
LVESV index, ml/m2 | 18.75 ± 4.07 | 17.20 ± 3.64* | 16.96 ± 4.49* | 0.025 |
LVEF, % | 65.44 ± 2.92 | 61.78 ± 3.26 | 61.15 ± 3.11 | 0.061 |
MAPSE, mm | 14.11 ± 2.45 | 14.52 ± 1.53 | 13.43 ± 2.16*# | 0.023 |
E, m/s | 0.82 ± 0.12 | 0.76 ± 0.14* | 0.75 ± 0.15* | 0.014 |
A, m/s | 0.68 ± 0.15 | 0.70 ± 0.17 | 0.80 ± 0.20* | < 0.001 |
E/A | 1.24 (1.16,1.37) | 1.06 (1.05,1.24) | 0.92 (0.90,1.12)*# | < 0.001 |
e′, m/s | 0.11 ± 0.02 | 0.10 ± 0.02* | 0.09 ± 0.02*# | < 0.001 |
E/e′ | 7.82 ± 1.48 | 8.25 ± 1.65 | 8.91 ± 2.44*# | 0.001 |
LVGLS, % | − 20.55 ± 1.90 | − 18.87 ± 2.04* | − 17.90 ± 1.94*# | < 0.001 |
Global myocardial work parameters
Global MW | Normal controls (n = 70) | T2DM (n = 60) | T2DM with HT (n = 60) | p value | p trend |
---|---|---|---|---|---|
GWI, mmHg% | 2186.87 ± 234.74 | 1965.82 ± 301.13* | 1966.95 ± 398.90* | < 0.001 | < 0.001 |
GCW, mmHg% | 2472.11 ± 295.81 | 2204.67 ± 350.34* | 2276.36 ± 380.65* | < 0.001 | 0.002 |
GWW, mmHg% | 51.00 (51.86,64.14) | 50.50 (53.96,74.21) | 67.00 (64.79,110.39) | 0.064 | 0.003 |
GWE, % | 97 (97,97) | 97 (96,97) | 97 (95,97)* | 0.002 | < 0.001 |
GCW/GWW | 46.82 (45.68,57.57) | 43.67 (38.09,51.92) | 37.72 (33.17,43.70)* | 0.004 | 0.002 |
Correlation and exposure factors
Variables | Univariable | Multivariable | ||
---|---|---|---|---|
r | p | β | p | |
Sex | 0.21 | 0.021 | 0.11 | 0.122 |
Age, year | − 0.13 | 0.149 | 0.08 | 0.305 |
BMI, kg/m2 | 0.10 | 0.282 | N/A | N/A |
HbA1c, % | − 0.01 | 0.932 | N/A | N/A |
TC, mmol/L | 0.14 | 0.136 | − 0.15 | 0.040 |
FPG, mmol/L | 0.11 | 0.241 | N/A | N/A |
BUN, mmol/L | − 0.17 | 0.081 | − 0.12 | 0.085 |
SBP, mmHg | 0.66 | < 0.001 | 0.70 | < 0.001 |
LVEF, % | − 0.01 | 0.908 | N/A | N/A |
MAPSE, mm | 0.32 | < 0.001 | 0.33 | < 0.001 |
R2 = 0.59 |
Construction and analysis of an ROC curve
ROC | GWI | GCW | GWE | GCW/GWW | Combined evaluation |
---|---|---|---|---|---|
Sensitivity, % | 55.83 | 40.83 | 44.17 | 55.83 | 50.00 |
Specificity, % | 84.29 | 92.86 | 75.71 | 65.71 | 92.86 |
AUC (95%CI) | 0.691 (0.621 to 0.756)* | 0.672 (0.601 to 0.738)* | 0.637 (0.564 to 0.705)* | 0.630 (0.557 to 0.699)* | 0.743 (0.675 to 0.804) |
Associated criterion | 2003.00 | 2128.00 | 96.00 | 40.96 | 0.74 |
p | < 0.001 | < 0.001 | < 0.001 | 0.002 | < 0.001 |
Intra- and interobserver variability analysis
Segmental MW parameters
LV segment | MWI (mmHg%) | p value | CW (mmHg%) | p value | WW (mmHg%) | p value | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Normal controls (n = 70) | T2DM (n = 60) | T2DM with HT (n = 60) | Normal controls (n = 70) | T2DM (n = 60) | T2DM with HT (n = 60) | Normal controls (n = 70) | T2DM (n = 60) | T2DM with HT (n = 60) | ||||
Inferior | 2392.44 ± 322.01 | 2207.60 ± 423.64* | 2119.74 ± 456.20* | < 0.001 | 2665.99 ± 389.76 | 2321.49 ± 417.59* | 2443.12 ± 495.12* | < 0.001 | 54.50 (54.24,75.75) | 46.83 (50.47,78.00) | 51.33 (49.95,95.08) | 0.726 |
Posterior | 2147.69 ± 297.11 | 2041.64 ± 473.71 | 1975.31 ± 465.65* | 0.033 | 2481.51 ± 382.65 | 2231.41 ± 456.34* | 2286.29 ± 429.56* | 0.002 | 67.33 (64.70,86.70) | 66.00 (64.38,117.40) | 82.33 (76.14,133.59) | 0.598 |
Lateral | 2137.70 ± 252.11 | 2046.84 ± 423.32 | 1905.41 ± 475.06* | 0.005 | 2445.94 ± 293.14 | 2179.14 ± 420.82* | 2204.69 ± 410.57* | < 0.001 | 51.33 (48.56,66.63) | 49.00 (47.64,70.36) | 60.00 (60.15,156.46) | 0.163 |
Anterior | 2117.25 ± 377.90 | 2021.17 ± 492.54 | 1880.75 ± 471.06* | 0.010 | 2380.10 ± 450.40 | 2045.19 ± 443.85* | 2107.92 ± 509.18* | < 0.001 | 41.00 (39.92,56.97) | 40.83 (42.74,68.44) | 69.00 (60.92,90.42)*# | 0.005 |
Anteroseptal | 2126.92 ± 309.43 | 2066.06 ± 472.11 | 2018.45 ± 504.12 | 0.331 | 2426.21 ± 371.00 | 2261.62 ± 478.87 | 2387.27 ± 515.83 | 0.100 | 32.00 (35.90,53.16) | 39.00 (38.25,83.04) | 46.67 (56.89,99.75) | 0.114 |
Septal | 2198.99 ± 262.80 | 2048.47 ± 331.90* | 1902.02 ± 448.96*# | < 0.001 | 2433.15 ± 308.60 | 2189.01 ± 382.66* | 2228.82 ± 454.86* | < 0.001 | 49.50 (47.22,66.33) | 45.67 (45.42,64.36) | 45.33 (47.01,124.91) | 0.991 |
LV segment | WE (%) | p value | CW/WW | p value | ||||
---|---|---|---|---|---|---|---|---|
Normal controls (n = 70) | T2DM (n = 60) | T2DM with HT (n = 60) | Normal controls (n = 70) | T2DM (n = 60) | T2DM with HT (n = 60) | |||
Inferior | 97.33 (96.52,97.33) | 97.33 (96.07,97.20) | 97.33 (95.64,97.20) | 0.955 | 47.10 (56.08,95.83) | 51.34 (46.86,128.56) | 47.58 (56.02,155.39) | 0.908 |
Posterior | 97.00 (96.06,96.92) | 96.83 (94.18,96.77) | 96.00 (93.87,96.23) | 0.287 | 36.70 (39.63,68.84) | 36.96 (37.35,67.46) | 28.37 (28.76,75.11) | 0.216 |
Lateral | 97.33 (96.75,97.46) | 97.33 (96.28,97.25) | 96.67 (93.66,96.71) | 0.109 | 45.22 (33.82,218.71) | 46.31 (47.70,119.31) | 32.58 (33.94,149.04) | 0.070 |
Anterior | 97.83 (97.02,97.72) | 97.00 (96.07,97.28) | 96.00 (94.98,96.42)* | < 0.001 | 58.63 (70.84,152.51) | 45.76 (54.53,120.04) | 28.67 (37.08,56.13)* | < 0.001 |
Anteroseptal | 98.00 (97.30,97.95) | 97.50 (95.37,97.80) | 97.33 (95.03,96.80)* | 0.048 | 72.62 (67.73,289.06) | 56.00 (64.29,151.62) | 49.52 (63.74,186.84) | 0.110 |
Septal | 97.33 (96.53,97.38) | 97.33 (96.17,97.15) | 97.00 (94.21,97.05) | 0.474 | 50.41 (23.05,252.47) | 47.14 (34.78,144.99) | 48.30 (56.02,110.71) | 0.590 |