The right ventricular dysfunction and ventricular interdependence in patients with DM: assessment using cardiac MR feature tracking

BackgroundTo investigate the difference of right ventricular (RV) structural and functional alteration in patients with diabetes mellitus (DM) with preserved left ventricular ejection fraction (LVEF), and the ventricular interdependence in these patients, using cardiac MR (CMR) feature tracking.MethodsFrom December 2016 to February 2022, 148 clinically diagnosed patients with DM who underwent cardiac MR (CMR) in our hospital were consecutively recruited. Fifty-four healthy individuals were included as normal controls. Biventricular strains, including left/right ventricular global longitudinal strain (LV-/RVGLS), left/right ventricular global circumferential strain (LV-/RVGCS), left/right ventricular global radial strain (LV-/RVGRS) were evaluated, and compared between patients with DM and healthy controls. Multiple linear regression and mediation analyses were used to evaluate DM's direct and indirect effects on RV strains.ResultsNo differences were found in age (56.98 +/- 10.98 vs. 57.37 +/- 8.41, p = 0.985), sex (53.4% vs. 48.1%, p = 0.715), and body surface area (BSA) (1.70 +/- 0.21 vs. 1.69 +/- 0.17, p = 0.472) between DM and normal controls. Patients with DM had decreased RVGLS (- 21.86 +/- 4.14 vs. - 24.49 +/- 4.47, p = 0.001), RVGCS (- 13.16 +/- 3.86 vs. - 14.92 +/- 3.08, p = 0.011), and no decrease was found in RVGRS (22.62 +/- 8.11 vs. 23.15 +/- 9.05, p = 0.743) in patients with DM compared with normal controls. The difference in RVGLS between normal controls and patients with DM was totally mediated by LVGLS (indirect effecting: 0.655, bootstrapped 95%CI 0.138-0.265). The difference in RVGCS between normal controls and DM was partly mediated by the LVGLS (indirect effecting: 0.336, bootstrapped 95%CI 0.002-0.820) and LVGCS (indirect effecting: 0.368, bootstrapped 95%CI 0.028-0.855).ConclusionsIn the patients with DM and preserved LVEF, the difference in RVGLS between DM and normal controls was totally mediated by LVGLS. Although there were partly mediating effects of LVGLS and LVGCS, the decrease in RVGCS might be directly affected by the DM.

Automated summary

This study investigated the difference in right ventricular (RV) structural and functional alteration in patients with diabetes mellitus (DM) with preserved left ventricular ejection fraction (LVEF), and the ventricular interdependence in these patients, using cardiac MR (CMR) feature tracking. The results showed that patients with DM had lower RVGLS and RVGCS compared to normal controls, with RVGRS showing no significant difference. The difference in RVGLS was fully mediated by LVGLS, while the difference in RVGCS was partly mediated by LVGLS and LVGCS.