Characteristics of Myocardial Perfusion in Type 2 Diabetes Mellitus and Its Association with Left Ventricular Diastolic Dysfunction: A Study of Myocardial Contrast Echocardiography

Figures

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  Figure 1. Flow chart of patient enrollment and grouping. LVDD+ group: patients diagnosed with LVDD; LVDD– group: patients with normal left ventricular diastolic function.

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  Figure 2. The replenishment curve formed after all microbubbles within an ultrasound field are destroyed by a single ultrasound pulse. It can be described by the following function: \documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$Y = A(1 - {e^{ - \beta t}})$$ \end{document}, which is used to derive parameters A and β. A is the plateau acoustic intensity reflecting myocardial blood volume, β is the rate of rise of acoustic intensity increase reflecting MP velocity, and A×β is the slope of the tangent to the curve at the origin, representing myocardial blood flow.18

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  Figure 3. Quantitative MCE analysis in a T2DM patient. Apical 2-, 3-, and 4-chamber views are observed at the end-systolic frame. Five ROIs are placed in the myocardium of the apical segment. The specific positions are as follows: apical septal and lateral segments, as well as apical cap in apical 4-chamber view (A); apical inferior and anterior segments, as well as apical cap apical in 2-chamber view (B); and apical lateral and anterior segments, as well as apical cap in apical long axis view (C). A, β, and A×β in each segment are obtained and all measurements are repeated 3 times to take the average. A represents myocardial blood volume, β represents myocardial perfusion velocity, and A×β represents myocardial blood flow.

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  Figure 4. Comparison of MBF (represented by A×β) between LVDD– and LVDD+ groups. Bars represent median with interquartile 25–75. The MBF in the LVDD+ group is significantly lower than in the LVDD– group (P value < 0.05). LVDD+ group: patients diagnosed with LVDD; LVDD– group: patients with normal left ventricular diastolic function.

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  Figure 5. Bland–Altman plots for intra-observer (A) and inter-observer (B) reproducibility of MCE parameter A×β. Both show small standard deviations. A×β represents myocardial blood flow.

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  Figure 6. ROC curve of MCE parameter A×β in the diagnosis of LVDD in T2DM patients. A×β represents myocardial blood flow.

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  Figure 7. Correlations of A×β with HbA1c (A) and diabetic duration (B). A×β is negatively correlated with HbA1c and diabetic duration (r = −0.226 and −0.350, both P values < 0.001).