Shanghai Jiaotong Daxue xuebao. Yixue ban (Aug 2023)
A study of the effect of suboptimal glycemic control on subclinical myocardial systolic function in patients with T2DM
Abstract
Objective·To explore the relationship between poor blood glucose control and early impaired cardiac function in patients with type 2 diabetes mellitus (T2DM).Methods·Eighty-three patients diagnosed with T2DM in Jiading Branch of Shanghai General Hospital from June 2021 to March 2022 were selected and divided into two groups according to the level of hemoglobin A1c (HbA1c): satisfactory control of glycaemia (SCG) group and less satisfactory control of glycaemia (LSCG) group. Fifty-four subjects were in the control group. Echocardiography was performed to obtain left ventricular structural and functional parameters and left ventricular subendocardial, medial and subepicardial global longitudinal strain (GLS): GLSendo, GLSmid, and GLSepi. The parameters were compared by using analysis of variance. The correlation analysis was performed by Pearson correlation analysis and multiple linear regression analysis. The diagnostic performance of longitudinal strain in differentiating subclinical myocardial dysfunction in patients with T2DM was analyzed by receiver operator characteristic (ROC) curve.Results·The thickness of the ventricular septum and the posterior wall of the left ventricle were thicker in the LSCG group than in the SCG group and the control group (all P0.05). Compared with the control group, the left ventricular diastolic function index E/e (early peak flow velocity by Doppler/early and atrial diastolic velocity of the mitral annulus by tissue Doppler imaging) was higher in both the LSCG group and the SCG group (all P 0.05). There was no significant difference in left ventricular ejection fraction among the three groups (P>0.05). Compared with LSCG group, GLSendo, GLSmid and GLSepi were higher in the SCG group and control group (all P0.05). HbA1c was an independently negative factor of GLSmid and GLSepi (β= -0.198 and -0.239, all P<0.05). GLSendo, GLSmid and GLSepi had moderate diagnostic performance between the LSCG group and SCG group, with areas under the curve (AUC) of 0.754 (95%CI 0.624‒0.884), 0.755 (95%CI 0.624‒0.885), and 0.751 (95%CI 0.619‒0.882), respectively.Conclusions·T2DM patients with unsatisfactory glycemic control have reduced myocardial contractility, and this subclinical myocardial damage is independently negatively correlated with the level of HbA1c.
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