Multimodal Echocardiography for Diagnostic Value of Type 2 Diabetes Mellitus Complicated with Left Anterior...

Type 2 diabetes mellitus (T2DM) significantly increases the risk of coronary heart disease (CHD), with left anterior descending artery (LAD) stenosis being a critical determinant of prognosis. While coronary angiography (CAG) and coronary computed tomography angiography (CCTA) are standard diagnostic tools, they have inherent limitations. This study aimed to evaluate the clinical value of multimodal echocardiography in assessing LAD stenosis severity in patients with T2DM.

In this retrospective case-control study, 96 T2DM patients with LAD stenosis ≥50% (by CAG) and 96 with <50% stenosis were consecutively enrolled. All participants underwent two-dimensional echocardiography (2DE), two-dimensional speckle tracking echocardiography (2D-STE), and coronary artery ultrasound imaging (CA-USI). Diagnostic performance was compared with CAG as the reference standard.

2D-STE and CA-USI demonstrated superior diagnostic performance for LAD stenosis compared to 2DE. Specifically, 2D-STE yielded an area under the curve (AUC) of 0.818, sensitivity of 0.760, and specificity of 0.875; CA-USI showed an AUC of 0.849, sensitivity of 0.802, and specificity of 0.895; while 2DE had an AUC of 0.583, sensitivity of 0.239, and specificity of 0.927. Group differences in regional wall motion abnormality, LAD plaque, global longitudinal strain, and peak diastolic velocity were all significant (P<0.05).

These findings indicated that 2D-STE and CA-USI outperformed conventional 2DE in detecting LAD stenosis among T2DM patients, providing more comprehensive functional and structural insights. The integration of strain imaging and coronary ultrasound enables earlier detection of subclinical myocardial impairment and plaque burden, offering practical value for risk stratification and longitudinal follow-up in diabetic populations. Compared with prior single-modality echocardiographic assessments, the multimodal approach in this study enhances diagnostic confidence and may reduce reliance on invasive CAG for preliminary evaluation. However, as a retrospective single-center analysis, potential selection bias and the modest sample size may limit generalizability. Future multicenter prospective trials are warranted to validate these findings and explore the incorporation of artificial intelligence-assisted analysis to improve precision and reproducibility.

Multimodal echocardiography, especially 2D-STE and CA-USI, provides a more accurate assessment of LAD stenosis in T2DM patients than conventional 2DE. Specifically, for detecting LAD stenosis ≥50%, 2D-STE achieved an AUC of 0.818, sensitivity of 0.760, and specificity of 0.875; CA-USI yielded an AUC of 0.849, sensitivity of 0.802, and specificity of 0.895; while 2DE had an AUC of 0.583, sensitivity of 0.239, and specificity of 0.927. These findings support the clinical utility of 2D-STE and CA-USI for comprehensive coronary evaluation in patients with T2DM.