Quantitative evaluation of myocardial work in patients with type 2 diabetes mellitus complicated with nonalcoholic fatty liver by noninvasive pressure-strain loop

Objective: To quantitatively evaluate myocardial work in patients with type 2 diabetes mellitus (T2DM) complicated with nonalcoholic fatty liver disease (NAFLD) by noninvasive pressure-strain loop (PSL). Methods: The study included 103 treatment-naive T2DM patients, categorized into three groups based on abdominal ultrasound findings: Group A (T2DM without NAFLD, n = 34), Group B (T2DM with mild NAFLD, n = 37), and Group C (T2DM with moderate to severe NAFLD, n = 32). All patients underwent echocardiography to assess left ventricular structure and systolic function. Apical four-chamber, two-chamber, and three-chamber echocardiographic images were collected. PSL analysis was used to obtain myocardial work parameters, including left ventricular global longitudinal strain (GLS), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global myocardial work efficiency (GWE). Results: Conventional echocardiographic showed no significant intergroup differences (P > 0.05). Group B demonstrated decreased GWI and GCW compared to Group A (P < 0.05). Group C showed decreased GLS, GCW, GWI, and GWE, along with increased GWW compared to Group A (P < 0.05). Additionally, Group C exhibited lower GLS, GCW, GWI, and GWE compared to Group B (P < 0.05). GLS demonstrated significant negative correlations with both GCW and GWI (r = -0.571 and r = -0.533, respectively; P < 0.001). Conclusion: PSL analysis provides a reliable quantitative assessment of left ventricular myocardial work in T2DM patients with NAFLD. This technique effectively detects early myocardial dysfunction and offers reproducible evaluation of global and regional cardiac function.