{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T20:21:10Z","timestamp":1787602870327,"version":"build-2736575974"},"reference-count":18,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2026,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n This study aimed to evaluate subclinical myocardial mechanical alterations by utilizing three\u2010dimensional speckle tracking imaging (3D\u2010STI) in patients with type 2 diabetes mellitus (T2DM) combined with subclinical hypothyroidism (SCH), and evaluate its intergroup discriminatory capacity.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A total of 147 participants were enrolled and divided into four groups: prediabetes group (\n n<\/jats:italic>\n = 37), isolated T2DM group (\n n<\/jats:italic>\n = 35), T2DM combined with SCH group (\n n<\/jats:italic>\n = 40), and healthy control group (\n n<\/jats:italic>\n = 35). Conventional echocardiographic indices, three\u2010dimensional myocardial strain parameters, and ventriculo\u2010arterial coupling indicators were compared among groups. Receiver operating characteristic (ROC) curves were plotted to evaluate the ability of myocardial strain parameters to identify individuals presenting early subclinical left ventricular myocardial mechanical abnormalities within the study cohort. Partial correlation analysis was performed to explore the independent correlation between thyroid\u2010stimulating hormone (TSH) and left ventricular functional parameters after adjusting for confounding variables. Multiple linear regression analysis was applied to assess the independent effect of TSH on myocardial comprehensive index (MCI) after adjusting for confounding factors.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Glycated hemoglobin (HbA1c) was elevated in the prediabetes, T2DM, and T2DM + SCH groups, while TSH was significantly higher in the T2DM + SCH group. Global longitudinal strain (GLS), left ventricular twist angle (LVtw), torsion (Tor), and myocardial comprehensive index (MCI) decreased progressively across the four groups. Effective arterial elastance (Ea) and ventriculo\u2010arterial coupling index (VAC) were increased in the T2DM and T2DM+SCH groups. ROC analysis demonstrated that MCI yielded the highest AUC (0.967) and sensitivity (97.30%) for prediabetes, and the optimal AUC (0.937), sensitivity (90.00%) and specificity (85.71%) for T2DM+SCH. Partial correlation analysis was performed after adjustment for age, sex, BMI, systolic blood pressure, diastolic blood pressure, triglycerides and HbA1c. The results revealed a significant negative correlation between TSH and MCI (\n r<\/jats:italic>\n = \u22120.616,\n p<\/jats:italic>\n < 0.01). Multivariate linear regression analysis was conducted with MCI as the dependent variable. After adjusting for age, sex, BMI, blood pressure, lipid and glucose metabolic parameters, TSH was independently negatively associated with MCI. When TG\u2010Ab and TPO\u2010Ab were added for exploratory analysis, elevated TSH remained independently associated with decreased MCI, while thyroid autoantibodies showed no independent effect. Partial correlation analysis indicated a moderate negative correlation between TSH and MCI (\n r<\/jats:italic>\n = \u22120.407,\n p<\/jats:italic>\n < 0.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 3D\u2010STI enables the identification of early subclinical myocardial mechanical alterations in patients with T2DM combined with SCH.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/echo.70594","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T17:25:04Z","timestamp":1786555504000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Three\u2010dimensional Speckle Tracking Imaging to Assess Subclinical Myocardial Mechanical Alterations in Patients With Type 2 Diabetes Mellitus Combined With Subclinical Hypothyroidism"],"prefix":"10.1111","volume":"43","author":[{"given":"Zijing","family":"Zhai","sequence":"first","affiliation":[{"name":"Department of Ultrasound Medicine Datong Third People's Hospital Datong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Medicine Datong Third People's Hospital Datong China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1630686"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejphar.2025.177826"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.9052"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001354"},{"issue":"1","key":"e_1_2_9_6_1","first-page":"S1","article-title":"Standards of Medical Care in Diabetes\u20142020","volume":"43","author":"American Diabetes Association","year":"2020","journal-title":"Diabetes Care"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.036107"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8121395"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.36628\/ijhf.2025.0052"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/echo.15650"},{"issue":"7","key":"e_1_2_9_11_1","article-title":"Three\u2010Dimensional Echocardiography and Strain Cardiac Imaging in Patients With Prediabetes and Type 2 Diabetes Mellitus","volume":"39","author":"Li Y.","year":"2025","journal-title":"Journal of Clinical Laboratory Analysis"},{"issue":"6","key":"e_1_2_9_12_1","first-page":"1041","article-title":"Usefulness of Two\u2010Dimensional Speckle\u2010Tracking Echocardiography in Detecting Subclinical Left Ventricular Systolic Dysfunction in Diabetes Mellitus","volume":"42","author":"Khair L. A.","year":"2025","journal-title":"Echocardiography"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1106968"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2025.133554"},{"issue":"5","key":"e_1_2_9_15_1","first-page":"296","article-title":"Alterations in Left Ventricular Twist and Torsion in Subclinical Hypothyroidism With Type 2 Diabetes Mellitus","volume":"52","author":"Wang L.","year":"2024","journal-title":"Journal of Clinical Ultrasound"},{"issue":"11","key":"e_1_2_9_16_1","first-page":"712","article-title":"Combined Longitudinal Strain and Twist Index for Detection of Early Subclinical Myocardial Damage in Prediabetic Subjects","volume":"51","author":"Zhai Z.","year":"2023","journal-title":"Journal of Clinical Ultrasound"},{"issue":"5","key":"e_1_2_9_17_1","first-page":"892","article-title":"Evaluation of the Relationship Between Left Atrial Stiffness, Left Ventricular Stiffness, and Left Atrioventricular Coupling Index in Type 2 Diabetes Patients: A Speckle Tracking Echocardiography Study","volume":"41","author":"Dang H. N. N.","year":"2024","journal-title":"Echocardiography"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/08037051.2025.2457698"},{"issue":"10","key":"e_1_2_9_19_1","article-title":"The Interplay Between Thyroid Disorders and Diabetes and Their Impact on Cardiovascular Outcomes: A Systematic Review","volume":"17","author":"Abdul Jaffar Azad A. R.","year":"2025","journal-title":"Cureus"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70594","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.70594","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70594","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T19:28:40Z","timestamp":1787599720000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.70594"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":18,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/echo.70594"],"URL":"https:\/\/doi.org\/10.1111\/echo.70594","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-07-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70594"}}