Background A noninvasive left ventricular (LV) pressure-strain loop (PSL) provides a new method to quantify myocardial work (MW) by combining global longitudinal strain (GLS) and LV pressure, which exerts potential advantages over traditional GLS. We studied the LV PSL and MW in patients with type 2 diabetes mellitus (T2DM). Methods This cross-sectional study included 201 subjects (54 healthy controls and 147 T2DM patients) who underwent complete two-dimensional echocardiography (2DE), including 2D speckle-tracking echocardiography (STE), as well as brachial artery pulse pressure measurement. The PSL was used to determine the global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) of all study participants. The association between T2DM and LV function was evaluated according to these MW indices. Results The GLS was significantly lower in the T2DM group than in the control group (P < 0.001), indicating that the LV myocardium had been damaged, although the LV ejection fraction (LVEF) was still normal. The GWI and GWE were decreased (P = 0.022) and the GWW was increased (P < 0.001) in diabetic patients compared with controls, but the GCW was comparable in the two groups (P = 0.160). In all diabetic patients, age, body mass index, systolic blood pressure, smoking history, and LVEF were correlated with GWI, GWW and GWE. Conclusions The use of LV PSL is a novel noninvasive technique that could help to depict the relationship between LV myocardial damage and MW in patients with T2DM.

Background Echocardiography is significant for the diagnosis of ruptured chordae tendineae (RCT) for which transesophageal echocardiography (TEE) is always better than transthoracic echocardiography (TTE), but the diagnostic accuracy of TTE still remains confusing. Methods A meta-analysis of included papers was performed to evaluate the diagnostic accuracy of TTE and TEE, with surgical findings of RCT as the gold standard of patients with suspected RCT. Results The literature search yielded 862 papers, 6 met the inclusion criteria, included 505 patients, for detecting RCT, the sensitivity and specificity of TTE were 48% (95% CI: 35–62%) and 98% (95% CI: 89–100%), and those of TEE were 99% (95% CI: 64–100%) and 94% (95% CI: 87–98%), respectively. The summary + LR, -LR of TTE were 22.40 (95%CI: 4.89–102.62), 0.53(95%CI:0. 41–0.68), respectively. The summary + LR, -LR of TEE were 17.62(95%CI: 7.16–43.39), 0.02(95%CI:0. 00-0.57), respectively. For TTE, the area under SROC was 84% (95%CI:92%-96%),and that of TEE is 98%. The pooled + LR and -LR were calculated by setting the prior probabilities of 20% in both TTE and TEE. Conclusions TTE is not highly sensitive for the detection of RCT but is highly specific, so there is a potential of missing diagnosis, and subsequent TEE is almost required in highly suspected patients.