Echocardiography. 2026 Aug;43(8):e70594. doi: 10.1111/echo.70594.
ABSTRACT
OBJECTIVE: This study aimed to evaluate subclinical myocardial mechanical alterations by utilizing three-dimensional speckle tracking imaging (3D-STI) in patients with type 2 diabetes mellitus (T2DM) combined with subclinical hypothyroidism (SCH), and evaluate its intergroup discriminatory capacity.
METHODS: A total of 147 participants were enrolled and divided into four groups: prediabetes group (n = 37), isolated T2DM group (n = 35), T2DM combined with SCH group (n = 40), and healthy control group (n = 35). Conventional echocardiographic indices, three-dimensional myocardial strain parameters, and ventriculo-arterial coupling indicators were compared among groups. Receiver operating characteristic (ROC) curves were plotted to evaluate the ability of myocardial strain parameters to identify individuals presenting early subclinical left ventricular myocardial mechanical abnormalities within the study cohort. Partial correlation analysis was performed to explore the independent correlation between thyroid-stimulating hormone (TSH) and left ventricular functional parameters after adjusting for confounding variables. Multiple linear regression analysis was applied to assess the independent effect of TSH on myocardial comprehensive index (MCI) after adjusting for confounding factors.
RESULTS: Glycated hemoglobin (HbA1c) was elevated in the prediabetes, T2DM, and T2DM + SCH groups, while TSH was significantly higher in the T2DM + SCH group. Global longitudinal strain (GLS), left ventricular twist angle (LVtw), torsion (Tor), and myocardial comprehensive index (MCI) decreased progressively across the four groups. Effective arterial elastance (Ea) and ventriculo-arterial coupling index (VAC) were increased in the T2DM and T2DM+SCH groups. ROC analysis demonstrated that MCI yielded the highest AUC (0.967) and sensitivity (97.30%) for prediabetes, and the optimal AUC (0.937), sensitivity (90.00%) and specificity (85.71%) for T2DM+SCH. Partial correlation analysis was performed after adjustment for age, sex, BMI, systolic blood pressure, diastolic blood pressure, triglycerides and HbA1c. The results revealed a significant negative correlation between TSH and MCI (r = -0.616, p < 0.01). Multivariate linear regression analysis was conducted with MCI as the dependent variable. After adjusting for age, sex, BMI, blood pressure, lipid and glucose metabolic parameters, TSH was independently negatively associated with MCI. When TG-Ab and TPO-Ab were added for exploratory analysis, elevated TSH remained independently associated with decreased MCI, while thyroid autoantibodies showed no independent effect. Partial correlation analysis indicated a moderate negative correlation between TSH and MCI (r = -0.407, p < 0.01).
CONCLUSION: 3D-STI enables the identification of early subclinical myocardial mechanical alterations in patients with T2DM combined with SCH.
PMID:42585205 | DOI:10.1111/echo.70594