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Increased fractal dimension of left ventricular trabeculations is associated with subclinical diastolic dysfunction in patients with type-2 diabetes mellitus

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Abstract

The aim of this study was to investigate the relationship among left ventricular (LV) concentric hypertrophy, endocardial remodeling, and myocardial deformation in type-2 diabetes mellitus (T2DM). Fifty-three T2DM patients with normotension and 36 healthy controls underwent cardiovascular magnetic resonance imaging to assess for LV concentric hypertrophy (LV myocardial mass index, LVMMi; LVMMi-to-LV end-diastolic volume index ratio, MVR), endocardial remodeling (fractal dimension of trabeculations, FD), and myocardial deformation (global longitudinal, radial and circumferential strain, systolic and diastolic strain rate). When compared with healthy controls, T2DM was associated with LV concentric hypertrophy (LVMMi: T2DM, 52.7 ± 8.9 g/m2; controls, 48.7 ± 8.4 g/m2, p = 0.032; MVR: T2DM, 0.88 ± 0.19 g/mL; controls, 0.77 ± 0.16 g/mL, p = 0.007), endocardial remodeling (max. apical FD: T2DM, 1.265 ± 0.056; controls, 1.233 ± 0.055, p = 0.008; mean apical FD: T2DM, 1.198 ± 0.043; controls, 1.176 ± 0.043, p = 0.020), and subtle diastolic dysfunction (peak longitudinal diastolic strain rate, PDSRL: T2DM, 1.1 ± 0.2/s; controls, 1.2 ± 0.3/s, p = 0.031). In the stepwise multivariable regression model, the MVR was an independent determinant of the maximum apical FD (standardized β, sβ = 0.525, p < 0.001) and mean apical FD (sβ = 0.568, p < 0.001). The mean apical FD was an independent determinant of the PDSRL (p = 0.004). LV concentric hypertrophy is an independent determinant of endocardial remodeling, a process that may contribute to subtle LV diastolic dysfunction in T2DM patients.

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Acknowledgements

This work was funded by the National Natural Science Foundation of China (Grant Numbers 81471647 and 81571748) and the National Key Research and Development Plan of China (Grant Number 2016YFC0107100) and SWH2016JSTSYB-18.

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Authors and Affiliations

  1. Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street No. 30, Shapingba District, Chongqing, China

    Yongning Shang, Xiaochun Zhang, Yanshu Shi, Jianlong Dong & Jian Wang

  2. Department of Endocrinology, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street No. 30, Shapingba District, Chongqing, China

    Weiling Leng, Xiaotian Lei, Liu Chen & Ziwen Liang

  3. MR Collaboration, Siemens Healthcare Ltd., Shanghai, China

    Xiaoyue Zhou

  4. Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, USA

    Kelvin Chow

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  1. Yongning Shang
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  2. Xiaochun Zhang
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Correspondence to Xiaochun Zhang, Ziwen Liang or Jian Wang.

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The authors declare that they have no competing interests.

Ethical approval

The Institutional Review Board (IRB) of our hospital approved this study, the reference number was 2016-Scientific-Research-No. 50, and all subjects gave informed consent. This study has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Shang, Y., Zhang, X., Leng, W. et al. Increased fractal dimension of left ventricular trabeculations is associated with subclinical diastolic dysfunction in patients with type-2 diabetes mellitus. Int J Cardiovasc Imaging 35, 665–673 (2019). https://doi.org/10.1007/s10554-018-1492-0

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  • DOI: https://doi.org/10.1007/s10554-018-1492-0

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