Myocardial Work Assessment in Type 2 Diabetic Kidney Disease using Left Ventricular Pressure-Strain Loops

Introduction/ Objective: This study evaluated changes in left ventricular myocardial function in patients with preserved ejection fraction and type 2 diabetes-related renal impairment using noninvasive pressure-strain loop analysis. METHODS: The urinary albumin-to-creatinine ratio was used to classify a cohort of 82 T2DKD patients, of whom 40 had microalbuminuria (group A) and 42 had macroalbuminuria (group B). During the same study period, 38 controls were recruited. Clinical data, conventional ultrasound parameters, and MW parameters were compared among the three groups. RESULTS: Significant reductions in Global Longitudinal Strain (GLS) were observed in Groups A and B (P < 0.05). Group B demonstrated a higher global work index and global constructive work than the control group (P < 0.05). Global Wasted Work (GWW) and Peak Strain Dispersion (PSD) increased progressively from the control group to Group A and Group B, while Global Work Efficiency (GWE) decreased progressively (P < 0.05). Systolic blood pressure, GLS, the E/e' ratio, and PSD were identified as independent determinants of the various MW parameters (P < 0.05). DISCUSSION: In patients with T2DKD, myocardial contractile function is already impaired during the microalbuminuric stage, even with preserved left ventricular ejection fraction, and this impairment worsens with progression to the macroalbuminuric stage. The identified independent determinants highlight the sensitivity of MW for detecting impaired myocardial function. CONCLUSION: LVPSL is useful for detecting early systolic dysfunction in patients with T2DKD. MW shows potential for the early detection of impaired myocardial function.