Quantitative Analysis of the Magnitude and Time Delay of Cyclic Variation of Myocardial Backscatter from Asymptomatic Type 2 Diabetes Mellitus Subjects

Abstract

Early detection of diabetic patients at high risk for developing diabetic cardiomyopathy may permit effective intervention. The goal of this work is to determine whether measurements of the magnitude and time delay of cyclic variation of myocardial backscatter, individually and in combination, can be used to discriminate between subgroups of individuals including normal controls and asymptomatic type 2 diabetes subjects. Two-dimensional parasternal long-axis echocardiographic images of 104 type 2 diabetic patients and 44 normal volunteers were acquired. Cyclic variation data were produced by measuring the mean myocardial backscatter level within a region-of-interest in the posterior wall, and characterized in terms of the magnitude and normalized time delay. The cyclic variation parameters were analyzed using Bayes classification and a nonparametric estimate of the area under the receiver operating characteristic (ROC) curve to illustrate the relative effectiveness of using one or two features to segregate subgroups of individuals. The subjects were grouped based on glycated hemoglobin (HbA1c), the homeostasis model assessment for insulin resistance (HOMA-IR), and the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C). Analyses comparing the cyclic variation measurements of subjects in the highest and lowest quartiles of HbA1c, HOMA-IR, and TG/HDL-C showed substantial differences in the mean magnitude and normalized time delay of cyclic variation. Results show that analyses of the cyclic variation of backscatter in young asymptomatic type 2 diabetics may be an early indicator for the development of diabetic cardiomyopathy.

Bayesian Parameter Estimation for Characterizing the Cyclic Variation of Echocardiographic Backscatter to Assess the Hearts of Asymptomatic Type 2 Diabetes Mellitus Subjects

“…1. More details of cyclic variation data acquisition and analysis are outlined by Gibson et al (2009).…”

“…Ultrasonic backscatter from myocardium has long been known to vary systematically over the cardiac cycle (Madaras et al, 1983; Mottley et al, 1984; Barzilai et al, 1984; Wickline et al, 1985; Mobley et al, 1995; Naito et al, 1996; Bello et al, 1998; Hu et al, 2003; Holland et al, 2004, 2007, 2009; Gibson et al, 2009). Quantification of this cyclic variation of myocardial backscatter has provided a tool for non-invasive ultrasonic tissue characterization in a range of pathologies, including diabetes (Gibson et al, 2009; Holland et al, 2007; Wagner et al, 1995; Bello et al, 1995; Pérez et al, 1992).…”

“…Quantification of this cyclic variation of myocardial backscatter has provided a tool for non-invasive ultrasonic tissue characterization in a range of pathologies, including diabetes (Gibson et al, 2009; Holland et al, 2007; Wagner et al, 1995; Bello et al, 1995; Pérez et al, 1992). Traditionally, cyclic variation has been quantified by using the magnitude and time delay (phase) of the systematic variation of backscatter over the heart cycle.…”

“…Traditionally, cyclic variation has been quantified by using the magnitude and time delay (phase) of the systematic variation of backscatter over the heart cycle. Both of these parameters have been shown to be useful for characterizing myocardial function (Holland et al, 2007; Gibson et al, 2009; Wagner et al, 1995; Bello et al, 1995; Hu et al, 2003; Finch-Johnston et al, 2000). However, other features of the cyclic variation waveform may be more sensitive to the early onset of diabetic cardiomyopathy.…”

Review of Quantitative Ultrasound: Envelope Statistics and Backscatter Coefficient Imaging and Contributions to Diagnostic Ultrasound

“…More recent application of these studies has been to characterize diabetes [80–81]. In one study, comparisons between normal subjects and patients with type 2 diabetes demonstrated that parameterization of the ultrasonic backscatter from the myocardium could differentiate between the hearts of diabetic patients based on their diabetic control.…”