Effect of serum bilirubin on myocardial function in patients with type 2 diabetes before cardiac structural changes
Objective:To preliminarily study the effect of serum bilirubin on myocardial function in patients with type 2 diabetes before cardiac structural changes.Methods:Eighty-nine patients with type 2 diabetes mellitus who met the inclusion criteria were selected as a diabetes group, and 67 subjects without a history of diabetes mellitus or cardiovascular and cerebravascular diseases were randomly selected from those who visited Jiading Branch of Shanghai First People's Hospital from December 2020 to June 2022 as a control group. The subjects' age, body mass index (BMI), systolic blood pressure (SBP), total cholesterol (TC), total triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), fasting plasma glucose (FPG), total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL); left ventricular end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD), interventricular septal dimensions (IVSD), and left ventricular posterior wall dimensions (LVPWD); and E/e', e'/a', left ventricular ejection fraction (LVEF), and left ventricular myocardial layered circumferential strain (GCSendo, GCSmid, and GCSepi) were compared between the two groups. Multivariate correlation analysis was used to analyze the correlation of bilirubin with blood biochemical indexes and left ventricular structure and function indexes.Results:Compared with the control group, the subjects in the diabetes group were older in age and had higher BMI, SBP, TG, FPG, and IBIL; had impaired left ventricular diastolic function, higher E/e', and lower e'/a'; and had lower GCSendo, GCSmid, and GCSepi (P<0.05 for all). Multivariate linear regression analysis showed that GCSmid and GCSepi were independent influencing factors of TBIL, DBIL, and IBIL; HDL and hemoglobin were independent influencing factors of TBIL; LDL was an independent influencing factor of DBIL; and hemoglobin was an independent influencing factor of IBIL (P<0.05 for all). Bland-Altman analysis showed that the measurement repeatability of the circumferential strain of myocardial stratification was good.Conclusion:Myocardial layered circumferential strain can be used to assess myocardial damage in diabetic patients at an early stage before the cardiac structure and LVEF are significantly damaged, and bilirubin has a protective effect on early myocardial damage in diabetes.
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