The adverse impact of coronary artery disease on left ventricle systolic and diastolic function in patients with type 2 diabetes mellitus: a 3.0T CMR study.

BACKGROUND: Coronary artery disease (CAD) confers considerable morbidity and mortality in diabetes. However, the role of CAD in additive effect of left ventricular (LV) function has rarely been explored in type 2 diabetes mellitus (T2DM) patients. This study aimed to investigate how CAD affect LV systolic and diastolic function in T2DM patients. MATERIALS AND METHODS: A total of 282 T2DM patients {104 patients with CAD [T2DM (CAD +)] and 178 without [T2DM (CAD -)]} and 83 sex- and age- matched healthy controls underwent cardiac magnetic resonance scanning. LV structure, function, global strains [including systolic peak strain (PS), peak systolic (PSSR) and diastolic strain rate (PDSR) in radial, circumferential and longitudinal directions] and late gadolinium enhancement (LGE) parameters were measured. T2DM (CAD +) patients were divided into two subgroups based on the median of Gensini score (60) which was calculated to assess the severity of CAD. Multivariable linear regression analyses were constructed to investigate the determinants of reduced LV function. RESULTS: Compared with normal controls, T2DM (CAD -) patients exhibited increased LV end-diastolic and end-systolic volume index and decreased LV global strains, while T2DM(CAD +) patients showed more marked increase and decrease than T2DM(CAD-) and healthy controls, except for longitudinal PDSR (PDSR-L) (all P < 0.017). All of LV global strains demonstrated a progressive decrease from normal controls, through Gensini score ≤ 60, to Gensini score > 60 group, except for PDSR-L (all P < 0.017). CAD was an independent predictor of reduced LV global circumferential PS (GCPS, ß = 0.22, p < 0.001), PSSR (PSSR-C, ß = 0.17, p = 0.005), PDSR (PDSR-C, ß = 0.22, p < 0.001), global radial PS (GRPS, ß = 0.19, p = 0.001), and global longitudinal PS (GLPS, ß = 0.18, p = 0.003) in T2DM. The Gensini score was associated with decreased GCPS, PSSR-C, PDSR-C, GRPS, and GLPS in T2DM (CAD +) (all p < 0.05). CONCLUSION: CAD has an additive deleterious effect on LV systolic and diastolic function in T2DM patients. Among T2DM (CAD +) patients, the Gensini score is associated with reduced LV contractile and diastolic function. Trial registration Retrospectively registered.

Integrating ecosystem services closely related to human well-being into the restoration and management of deep lakes facing multiple stressors: Lessons from long-term practice in Qiandao Lake, China.

Deep-lake (reservoir) ecosystems provide valuable ecosystem services (ES) and generate significant ecosystem service values (ESV); however, reservoir ecosystems have suffered great losses from environmental changes and human activities. Currently, studies on ES and its correlations with stressors remain insufficient and the integration of ES into ecological restoration and management poses numerous challenges. Here, we combined four types of stressors with six ES closely related to human well-being to discuss their interactions in Qiandao Lake (a representative deep lake in China). Our results indicate that all ESV showed a consistent growth trend throughout the study period, reaching 5203.8 million CNY in 2018, and the cultural service value surpassed the provisioning service value for the first time in 2004. Almost all the ESV were limited during the cyanobacterial bloom in Qiandao Lake. Redundancy analysis and partial least squares structural equation modeling jointly revealed that socioeconomic development was the most important direct driver of the increase in ESV (0.770) and that hydro-meteorological conditions (0.316) and pollutant loads (0.274) positively affected ESV by mediating lake trophic status. The trophic status of the lake is the result of the interaction of multiple stressors, which has a negative impact on ESV. Therefore, to continuously protect the provisioning and cultural service values of deep-lake ecosystems from damage, the government must rationally formulate SED goals and reduce pollutant loads during lake development, operation, and utilization. This work provides valuable insights into the interactions between ES, which are closely related to human well-being, and stressors in deep-lake ecosystems.