Quantitative Analysis of Myocardial Work in Gestational Diabetes Mellitus Using Noninvasive Left Ventricular Pressure-Strain Loop Measurement

IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2024-10-10 DOI:10.1111/echo.15944
Jiaqi Zhang, Caihong Chang, Changxiu Yu, Yao Peng, Wei Feng, Juan Song, Ji Wu
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Abstract

Background

Gestational diabetes mellitus (GDM) poses a risk for cardiovascular damage during pregnancy. This study focused on evaluating changes in left ventricular myocardial performance in GDM patients using the left ventricular pressure-strain loop (LV-PSL) method and examining risk factors associated with reduced myocardial function.

Methods

A prospective, randomized study involving 112 pregnant women diagnosed with GDM was conducted from June 2021 to June 2024. Additionally, 84 healthy pregnant women from the same period served as the control group. Utilizing both conventional echocardiography and two-dimensional speckle tracking echocardiography, left ventricular myocardial work metrics were assessed using LV-PSL technology.

Results

GDM patients demonstrated significantly reduced values for global longitudinal strain (GLS), global work index (GWI), global work efficiency (GWE), and global constructive work (GCW) (p < 0.05), while conventional ultrasound measures showed no significant difference between GDM and control groups. GWI, GWE, GCW, and GLS had high predictive value for cardiac function changes in GDM patients, with GWE showing the highest predictive value {Area under curve (AUC) = 0.866, cutoff value = 95.5%, specificity = 0.77, sensitivity = 0.87}. GWI, GWE, and GCW were negatively correlated with GLS (r = −0.532, −0.411, −0.425, all p < 0.001), whereas global wasted work (GWW) showed a positive correlation with GLS (r = 0.325 and p < 0.001). These parameters were also correlated with HbA1c levels (r = −0.316, −0.256, −0.260, all p < 0.001 for negative correlations, and r = 0.172, p < 0.05 for positive correlations). Multivariate logistic regression indicated that 1-h OGTT (mmol/L), 2-h OGTT (mmol/L), and HbA1c (%) were significant predictors of left ventricular systolic function (GWE) in GDM patients.

Conclusions

LV-PSL is an effective tool for early detection of left ventricular systolic function impairment in GDM patients.

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利用无创左心室压力-应变环路测量法定量分析妊娠期糖尿病患者的心肌功。
背景:妊娠期糖尿病(GDM)会对妊娠期心血管造成损害。这项研究的重点是使用左心室压力应变环(LV-PSL)方法评估GDM患者左心室心肌功能的变化,并研究与心肌功能下降相关的风险因素:一项前瞻性随机研究于 2021 年 6 月至 2024 年 6 月进行,涉及 112 名确诊为 GDM 的孕妇。此外,同期的 84 名健康孕妇作为对照组。利用传统超声心动图和二维斑点追踪超声心动图,使用 LV-PSL 技术评估左心室心肌工作指标:GDM患者的总体纵向应变(GLS)、总体做功指数(GWI)、总体做功效率(GWE)和总体建设性做功(GCW)值明显降低(P < 0.05),而常规超声检查结果显示GDM组与对照组之间无明显差异。GWI、GWE、GCW和GLS对GDM患者的心功能变化具有较高的预测价值,其中GWE的预测价值最高{曲线下面积(AUC)=0.866,临界值=95.5%,特异性=0.77,敏感性=0.87}。GWI、GWE 和 GCW 与 GLS 呈负相关(r = -0.532、-0.411、-0.425,均 p <0.001),而全局耗功(GWW)与 GLS 呈正相关(r = 0.325,p <0.001)。这些参数还与 HbA1c 水平相关(r = -0.316、-0.256、-0.260,负相关均 p <0.001;r = 0.172,正相关 p <0.05)。多变量逻辑回归显示,1 小时 OGTT(毫摩尔/升)、2 小时 OGTT(毫摩尔/升)和 HbA1c(%)是 GDM 患者左心室收缩功能(GWE)的重要预测因素:LV-PSL是早期检测GDM患者左心室收缩功能损伤的有效工具。
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来源期刊
CiteScore
2.40
自引率
6.70%
发文量
211
审稿时长
3-6 weeks
期刊介绍: Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.
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