Differential Changes of Left Ventricular Myocardial Deformation in Three-vessel Critical Stenosis CAD Patients with and without Diabetes: A Two-dimensional Speckle-tracking Echocardiography-based Study.

BackgroundThough the presence of three-vessel disease (3VD) coronary artery disease (CAD) among patients with type 2 diabetes mellitus (T2DM) is relatively common, very limited data is regarding their left ventricular (LV) function. The purpose of our study is to assess the LV function in 3VD patients with T2DM by two-dimensional speckle tracking echocardiography (2-D STE).MethodsHundred-three consecutive patients with confirmed 3VD CAD were enrolled and divided into two groups, 53 patients with DM and 50 patients without DM. The control group was composed of 30 age- and sex-matched healthy individuals. Echocardiography was performed at baseline before coronary angiography. The 2-D STE was used to measure LV global longitudinal strain (GLS) and segmental peak systolic longitudinal strains (PSLSs).ResultBy standard echocardiogram, there is no significant difference between 3VD-DM and 3VD-non-DM groups. Strains measured by 2-D STE showed that the 3VD-DM patients have significantly lower global longitudinal strain (GLS) than the 3VD-non-DM patients (15.87 ± 2.51 vs.17.56 ± 2.72, P < 0.05). Further, in the 3VD-DM groups, the duration of the DM and glucose control level were investigated. Our results showed that GLS of the duration of DM≥5 of 3VD was significantly lower than that in 3VD patients with duration of DM<5, especially in global PSLS (14.25 ± 2.31 vs. 16.65 ± 1.96, P=0.007), mid PSLS (14.08 ± 3.72 vs. 16.51 ± 2.15，P=0.017), and apical PSLS (15.26 ± 3.28 vs.18.44 ±4.36，p=0.049). However, the results of the glucose control level showed no difference on GLS between the 3VD patients with HbA1c ≥ 7% and HbA1c < 7%.ConclusionsGlobal and segmental peak systolic longitudinal strains (PSLSs) are significantly lower in 3VD-DM patients than in the patients with 3VD only. The duration of diabetes is an important factor cause the decrease GLS in 3VD-DM patients. However, the glucose control level has limited influence on LV function in 3VD patients.