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060) 3.73±0.22 3.8 [3.5, 3.9] (N=23) 3.63±0.20 3.6 [3.5, 3.8] (N=47) 1_38.86, 0.003 2"32.905, 0.088
2.493, 0.114 1.360, 0.244 6.352, 0.012
LA volume, ml / 1, 2 61.10±5.31 60.0 [59.0, 64.0] 47.35±6.44 46.0 [40.5, 54.0] 43.55±7.55 41.0 [38.0, 50.0] 1_244.37, 0.00 1_366.35, 0.00 2"35.17, 0.02
58.83±5.66 58.0 [55.0, 61.2] 46.61±7.41 45.0 [40.0, 53.0] 42.53±8.11 39.0 [36.0, 48.5] 1_231.05, 0.00 1_355.51, 0.00 2"36.20, 0.01
(t, P) 1st and 2nd visit 9.519, 0.002 0.329, 0.566 1.527, 0.217
30.85±2.89 30.5 [29.0, 32.5] 22.89±2.69 23.15±3.42 23.1 [20.6, 24.7] 1_245.64, 0.00
ind. LA volume, ml/m2/ 1, 2 22.5 [20.8, 24.5] 1 361.66, 0.00
29.62±3.02 29.3 [28.0, 32.0] 22.65±3.40 22.4 [20.2, 25.6] 22.60±3.68 22.0 [20.4, 23.7] i"236.77, 0.00 i"354.95, 0.00
(t, P) 1st and 2nd visit 5.189, 0.023 0.314, 0.575 1.244, 0.265
CDR cm/ 1, 2 5.69±0.71 5.8 [5.2, 6.1] 5.31±0.66 5.2 [4.9, 5.7] 5.83±6.24 4.9 [4.5, 5.3] i"25.37, 0.02 i"326.03, 0.00 2"34.72, 0.03
5.53±0.66 5.4 [5.1, 6.0] 5.30±0.55 5.2 [4.9, 5.5] 4.91±0.57 4.8 [4.5, 5.3] i"22.93, 0.08 i"321.53, 0.00 2"36.72, 0.01
(t, P) 1st and 2nd visit 2.130, 0.144 0.001, 0.974 0.074, 0.785
DAC cm/ 1, 2 4.20±0.66 4.2 [3.7, 4.7] 3.55±0.56 3.4 [3.2, 3.8] 3.17±0.43 3.2 [2.8, 3.5 i"215.69, 0.00 i"349.89, 0.00 2"37.36, 0.007
4.08±0.65 4.0 [3.5, 4.6] 3.64±0.53 3.4 [3.3, 4.0] 3.20±0.47 3.2 [2.8, 3.5] i"244.37, 0.00 i"366.35, 0.00 2"35.17, 0.02
(t, P) 1st and 2nd visit 1.605, 0.205 0.167, 0.683 0.083, 0.773
With a natural intergroup difference in LV mass and indexed LVMM volume, a statistically significant decrease was recorded in the group of patients with moderately reduced LVEF (Group A) A 26.68 (1=3.630, p=0.057) and A 13.6 (1=5.285, p=0.022) respectively. There was a difference in LV mass in groups 2 and 3 (divided by H2FPEF scale) 232.5 [207.8, 283.1] versus 211.1 [175.0, 235.0] (t=5.73, p=0.01) at baseline. At the observation stage, a decrease in the LV mass parameter
was recorded in groups 2 (t=0.679, p=0.410) and 3 (t=0.394, p=0.530), but the intergroup difference was not significant (t=0.394, p=0.530). According to the LV myocardial mass index, there was an intergroup difference of 1 and 2 (t=8.94, p=0.003), 1 and 3 groups before (t=20.8, p=0.000), respectively, and after 2 years of observation1 2 (t=5.52, p =0.019) and 1 3(t=11.1, p=0.001), respectively. The most interesting are the identified intragroup differences when analyzing the parameters of the right atrium and pulmonary artery SBP (PA SBP). In the absence of changes in the dynamics of observation (2 years), PP and SBP of the LA in A (t = 0.285, p = 0.593) and (t = 0.082, p = 0.775) and in groups (t = 0.012, p = 0.912) and (t =0.118, p=0.731) significant differences were revealed between 2 and 3 groups in patients with preserved LVEF with different probability of HF according to the analyzed H2FPEF scale. Thus, in patients with type 2 diabetes with coronary artery disease, the PP index in group 2 before treatment was 3.1 [3.0, 3.4] mm versus group 3 2.7 [2.3, 3.2] mm2 3 (t = 5.73, p = 0.01), respectively, continuing to maintain this a tendency to difference after 2 years of observation 3.2 [2.8, 3.5] mm - 2.8 [2.5, 3.1]2 3(t= 5.66, p=0.01), respectively. Similar differences can be seen in LA SBP indicator, group 2 before treatment 28.0 [17.0, 30.0] mm versus group 3 23.0 [16.0, 28.0]2"3(t=1.690, p=0.694), clearly manifested at the stage of therapy 26.0 [21.5, 30.5 ] versus group 3 24.0 [16.5, 28.0] 2 3(t=3.1, p=0.074) due to differences in outcome indicators.
Table 2.
EchoCG and LVDP parameters in patients with coronary artery disease with diabetes mellitus-2 with different categories of LVEF at the stages of observation. (M±d, M (Q1-Q3).
FV>50, n-70 V group
EF <50, n-60 A group (1) H2FPEF, P>50% (N=23) (2) H2FPEF, P<50% (N=47) (3) (t, P)
LV mass, g/m2,/ 1, 2 292.28±93.11 297.6 [237.5, 337.1] 249.83±62.00 232.5 [207.8, 283.1] 212.34±57.87 211.1 [175.0, 235.0] i"25.28, 0.021 1323.18, 0.00 2"35.734, 0.01
265.60±81.49 260.5 [205.1, 305.8] 236.46±59.16 222.7 [195.7, 273.5] 207.54±66.15 200.1 [164.0, 249.9] i"314.39, 0.00
(t, P) 1st and 2nd visit 3.630, 0.057 0.679, 0.410 0.394, 0.530
LVM index/ 1, 2 146.20±42.17 149.3 [119.0, 169.0] 121.03±31.04 115.9 [100.1, 127.7] 112.59±26.57 111.1 [94.4, 126.8] i"28.948, 0.003 i"320.82, 0.000
132.64±37.64, 126.3 [108.1, 156.4] 115.56±32.80 104.0 [96.3, 123.9] 109.58±30.43 106.3 [89.0, 131.6] 1_25.524, 0.019 1_3n.n, 0.001
(t, P) 1st and 2nd visit 5.285, 0.022 0.956, 0.328 0.463, 0.496
PP, cm-/ 1, 2 3.41±0.65 3.4 [3.0, 3.6] 3.10±0.40 3.1 [3.0, 3.4] 2.83±0.76 2.7 [2.3, 3.2] 1_24.81, 0.028 1_323.5, 0.000 2"35.73, 0.01
3.46±0.69 3.5 [3.0, 3.8] 3.13±0.53 3.2 [2.8, 3.5] 2.85±0.76 2.8 [2.5, 3.1] 1_23.37, 0.066 1_322.9, 0.000 2 35.66, 0.01
(t, P) 1st and 2nd visit 0.285, 0.593 0.341, 0.559 0.149, 0.699
MPAP, mm Hg / 1, 2 29.10±9.48 28.0 [24.0, 33.2] 25.22±9.24 28.0 [17.0, 30.0] 22.17±7.12 23.0 [16.0, 28.0] 1_314.3, 0.000
29.83±7.84 28.0 [26.0, 32.2] 25.91±7.05 26.0 [21.5, 30.5] 22.19±7.09 24.0 [16.5, 28.0] 1_24.34, 0.037 1_320.8, 0.000 2"33.19, 0.074
(t, P) 1st and 2nd visit 0.082, 0.775 0.001, 0.974 0.000, 0.991
It is noteworthy that the main indicators of LVDP with a fairly high statistically significant power respond to therapy in the dynamics of observation: the average peak speed of early diastolic movement of the septal and lateral parts of the mitral fibrous ring (e'average) in 1 |A 0.2 cm/sec (t=12.702, p=0.000) |A 0.19 cm/sec (t=4.879, p=0.027) in 2 groups [7].
The average index of early diastolic filling of the LV (E/e') at the beginning of observation had pronounced differences between groups (t=9.917, p=0.002) and at the stage (t=3.996, p=0.046).
The severity of index recovery was noted in both groups 1 (t=21.526, p=0.000) and 2 (t=10.374, p=0.001).
Table 3.
EchoCG and LVDP parameters in patients with coronary artery disease with diabetes mellitus-2 with different categories of LVEF at the stages of observation. (M±d, M (Q1-Q3).
FV>50, n-70 V group
Index/ Visit EF <50, n-60 A group (1) H2FPEF, P>50% (N=23) (2) H2FPEF, P<50% (N=47) (3) (t, P)
E m/sec/ 1.2 0.73±0.19 0.7 [0.6, 0.9] 0.63±0.07 0.6 [0.6, 0.7] 0.61±0.06 0.6 [0.6, 0.7] 1_36.312, 0.012
0.69±0.17 0.6 [0.5, 0.9] 0.61±0.05 0.6 [0.6, 0.6] 0.58±0.05 0.6 [0.6, 0.6] 1_36.930, 0.008 2"36.011, 0.014
(t, P) 1st and 2nd visit 3.500, 0.061 1.776, 0.183 8.636, 0.003
A m/sec/1.2 0.75±0.10 0.7 [0.7, 0.8] 0.84±0.10 0.8 [0.8, 0.9] 0.81±0.09 0.8 [0.8, 0.8] 1_210.34, 0.001 1_39.024, 0.003
0.76±0.11 0.8 [0.7, 0.8] 0.84±0.08 0.8 [0.8, 0.9] 0.81±0.07 0.8 [0.8, 0.9] 1_210.08, 0.001 1_37.465, 0.006
(t, P) 1st and 2nd visit 0.237, 0.626 0.269, 0.604 0.163, 0.687
E/A / 1, 2 1.02±0.37 0.8 [0.8, 1.4] 0.75±0.06 [ 0.8 [0.7, 0.8] 0.75±0.05 0.8 [0.7, 0.8] 1_27.08, 0.008 1_312.1, 0.000
0.94±0.34 0.8 [0.7, 1.3] 0.72±0.05 0.7 [0.7, 0.8] 0.71±0.05 0.7 [0.7, 0.7] 1_26.57, 0.010 1_316.7, 0.000
(t, P) 1st and 2nd visit 6.725, 0.010 6.727, 0.009 15.830, 0.000
e septal, cm/sec / 12 5.87±0.42 5.8 [5.5, 6.2] 5.79±0.31 5.7 [5.5, 6.0] 5.74±0.36 5.7 [5.5, 6.0]
6.05±0.36 6.0 [5.7, 6.3] 5.93±0.33 5.9 [5.7, 6.1] 5.92±0.37 5.9 [5.5, 6.2]
(t, P) 1st and 2nd visit 5.631, 0.018 1.695, 0.193 5.117, 0.024
e lateral cm/sec / 12 8.16±0.68 8.0 [7.8, 8.6] 8.09±0.45 8.1 [7.8, 8.4] 8.10±0.39 8.1 [7.8, 8.3]
8.35±0.64 8.28±0.45 8.40±0.40
8.3 [8.0, 8.8] 8.3 [8.0, 8.6] 8.5 [8.2, 8.7]
(t, P) 1st and 3.465, 0.063 2.093, 0.148 13.204, 0.000
2nd visit
e average, cm/s 7.02±0.47 6.94±0.34 6.92±0.32
/ 12 7.0 [6.7, 7.5] 7.0 [6.7, 7.1] 6.9 [6.7, 7.1]
7.20±0.41 7.10±0.35 7.16±0.31
7.2 [6.9, 7.5] 7.0 [6.9, 7.3] 7.2 [7.0, 7.4]
(t, P) 1st and 4.527, 0.033 1.892, 0.169 11.946, 0.001
2nd visit
E/e' / 1, 2 10.38±2.20 9.09±0.92 8.84±0.93 1_310.8,
9.8 [8.6, 12.9] 9.3 [8.5, 9.7] 8.8 [8.2, 9.6] 0.001
9.23±1.97 8.52±0.62 8.08±0.66 1_36.27,
8.7 [7.5, 10.4] 8.7 [8.3, 8.9] 8.1 [7.6, 8.5] 0.012 2"37.02, 0.008
(t, P) 1st and 9.901, 0.002 7.422, 0.006 17.775, 0.000
2nd visit
1 Degree 65.0% (39) 100.0% (23) 100.0% (47)
LVDD [1] 71.7% (43) 100.0% (23) 100.0% (47)
(t, P) 1st and inf, 0.000 inf, 0.000 inf, 0.000
2nd visit
2 Degree 35.0% (21) 0.0% (0) 0.0% (0)
LVDD 28.3% (17) 0.0% (0) 0.0% (0)
(t, P) 1st and 1.312 0.252 inf, 0.000 inf, 0.000
2nd visit
Changes were identified in indicators that determine structural changes according to the recommendations of the ESC and RKO/OSSN/RNMOT in the parameter i-LVMM (t=7.677,
p=0.006) between groups 1 and 2 (and groups 2 and 3 (t=5.53, p=0.01) .
Indicators, the presence of which determines structural changes according to the
recommendations of the ESC and RKO/OSSN/RNMOT*
Index EF>50%
EF <50% EF>50% P<=50% t, p 1 CO t, p 2 c
(1) P>50% (2) (3) 2 t, p 1 c 3 3
LA I-volume
(>34 ml/m2) 18.3% nan,
(11) 0.0% (0) 0.0% (0) inf, 0.000 inf, 0.000 nan
38.3% 52.2% 40.4% 7.677 0.182, 5.53,
I-LVMM (23) (12) (19) 0.006 0.670 0.01
M>115/F>95 100.0% 100.0% 100.0% nan,
e aver< 9 cm/s (60) (23) (47) nan, nan nan, nan nan
25.0% nan,
E/e >13 (15) 0.0% (0) 0.0% (0) inf, 0.000 inf, 0.000 nan
Conclusion. In the initial echocardiographic indicators of intracardiac hemodynamics, a statistically significant difference was revealed between groups A and B. At the observation stage, patients in group A recorded a statistically significant increase in LVEF (p = 0.000), a decrease in LA volume (p = 0.002), and LVMM (p = 0. 05), LVMM index (p=0.02). the ratio of early and late mitral velocity E/A showed a significant decrease (t=6.725, p=0.010). The dynamics of the indicator of the speed of movement of the lateral sections of the fibrous ring of the mitral valve in the early diastole phase is noted, e average (t = 4.527, 0.033). It is noteworthy that the main indicators of LVDP with a fairly high statistically significant power respond to therapy in the group with LVEF 41-49%. These include a decrease in: LA volume (p=0.002), indexed LA volume (p=0.024), LVMM index (p=0.024), E/A in both groups (t==0.000 and p=0.007), transmitral velocity ratio and transtricuspid flow in early diastole to the speed of movement of the lateral part of the fibrous ring of the mitral and tricuspid valves in both groups E/e" (t==0.000, and p=0.001). The parameter of the ratio of the peak velocity of mitral inflow during early diastole (E) to the average velocity of the septal and lateral mitral annular early diastolic peak (e') - E/e' reflects the LV filling pressure, and the parameters are found in the "gray zone" and decrease (t =9.901, 0.002), which indirectly indicates an improvement in diastolic function.
In patients of group B, to determine the probability of HF using the H2FPEF scale, differences were identified in the following initial indicators between groups 2 and 3: LA volume (t==5.17, 0.02). ESR (t==4.72, p=0.03), ESR (t==7.36, p=0.007), LVMM (t==5.734, p=0.01). PP (t==5.73, p=0.01), PA SBP (t==3.19, p=0.07) retaining their direction at the observation stage. The values of LVDP between groups 2 and 3 at the outcome differed in the E/e" indicator (t==7.02, p=0.008), due to the E parameter (t==6.011, and p=0.01). At the observation stages, positive dynamics were recorded on the part of E/A in groups 2 (t==6.727, p=0.009) and 3 (t==15.830, p=0.000), E/e' (t==7.422, p=0.006 ) and (t==17.775, p=0.000) respectively.
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