Correlation Between Type II Diabetes Mellitus and Left Atrial Function as Assessed by 2D Speckle-Tracking Echocardiography in Patients Without Coronary Artery Disease

Document Type : Original Article

Authors

1 Department of Cardiology, Modarres Hospital Research and Development Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

2 Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Diabetes mellitus (DM) is associated with several comorbidities and complications such as hypertension, obesity, hyperlipidemia, nephropathy, and cardiovascular diseases. This study aimed to investigate the correlation between the left atrial (LA) function and DM via conventional and speckle-tracking echocardiography (STE).
Methods: In this prospective study, from 198 patients with sinus rhythms, 174 patients were included based on inclusion and exclusion criteria. Conventional and STE examinations were done for all the patients. The patients’ demographics, comorbidities, and family history, as well as the results of their angiography or computed tomography angiography, electrocardiography, and echocardiography, were recorded. The variables were compared between the groups with and without DM, and the association between the LA function and DM was studied in the patients.
Results: Totally, 45.2% of the diabetic patients (n = 28) and 38.4% of the nondiabetic patients (n = 30) had diastolic dysfunction (P = 0.384). The diabetic patients had a lower mean of the left ventricular end-diastolic diameter, the LA peak strain during the reservoir phase, the LA pump, and the LA peak positive strain rate during ventricular systole (all Ps < 0.001) and a higher mean of the left ventricular mass index, the A-wave, the E/A, the LA peak negative strain rate during early diastole (all Ps <0.001), the left ventricular end-systolic volume (P = 0.001), the Ea (P = 0.008), the LA ejection fraction (P = 0.011), and the passive emptying volume (P = 0.026).
Conclusions: The results of the present study indicated LA and left ventricular dysfunction in diabetic patients. However, the LA function may be affected by several factors, and our nonrandomized patient selection could also have affected the results. Thus, it is suggested that future randomized clinical trials compare the LA echocardiographic parameters in matched groups. 

Keywords


1. Whiting DR, Guariguata L, Weil C, Shaw J.
IDF diabetes atlas: global estimates of the
prevalence of diabetes for 2011 and 2030.
Diabetes research and clinical practice.
2011;94(3):311-21.
2. Olokoba AB, Obateru OA, Olokoba LB.
Type 2 diabetes mellitus: a review of current
trends. Oman medical journal.
2012;27(4):269.
3. Haghdoost A, Rezazadeh Kermani M,
Sadghirad B, Baradaran H. Prevalence of
type 2 diabetes in the Islamic Republic of
Iran: systematic review and meta-analysis.
2009.
4. Azimi-Nezhad M, Ghayour-Mobarhan M,
Parizadeh M, Safarian M, Esmaeili H,
Parizadeh S, et al. Prevalence of type 2
diabetes mellitus in Iran and its relationship
with gender, urbanisation, education, marital
status and occupation. Singapore medical
journal. 2008;49(7):571.
5. Tanjani PT, Moradinazar M, Mottlagh ME,
Najafi F. The prevalence of diabetes mellitus
(DM) type II among Iranian elderly
population and its association with other
age-related diseases, 2012. Archives of
gerontology and geriatrics. 2015;60(3):373-
9.
6. Fowler MJ. Microvascular and
macrovascular complications of diabetes.
Clinical diabetes. 2008;26(2):77-82.
7. Amini M, Parvaresh E. Prevalence of
macro-and microvascular complications
among patients with type 2 diabetes in Iran:
a systematic review. Diabetes research and
clinical practice. 2009;83(1):18-25.
8. Long AN, DagogoJack S. Comorbidities of
diabetes and hypertension: mechanisms and
approach to target organ protection. The
Journal of Clinical Hypertension.
2011;13(4):244-51.
9. Lin EH, Heckbert SR, Rutter CM, Katon
WJ, Ciechanowski P, Ludman EJ, et al.
Depression and increased mortality in
diabetes: unexpected causes of death. The
Annals of Family Medicine. 2009;7(5):414-
21.
10. Khalil CA, Roussel R, Mohammedi K,
Danchin N, Marre M. Cause-specific
mortality in diabetes: recent changes in trend
mortality. European journal of preventive
cardiology. 2012;19(3):374-81.
11. O'Donnell MJ, Xavier D, Liu L, Zhang H,
Chin SL, Rao-Melacini P, et al. Risk factors
for ischaemic and intracerebral
haemorrhagic stroke in 22 countries (the
INTERSTROKE study): a case-control
study. The Lancet. 2010;376(9735):112-23.
12. Thiruvoipati T, Kielhorn CE, Armstrong EJ.
Peripheral artery disease in patients with
diabetes: Epidemiology, mechanisms, and
outcomes. World journal of diabetes.
2015;6(7):961.
13. Chawla A, Chawla R, Jaggi S. Microvasular
and macrovascular complications in diabetes
mellitus: distinct or continuum? Indian
journal of endocrinology and metabolism.
2016;20(4):546.
14. Giacco F, Brownlee M. Oxidative stress and
diabetic complications. Circulation research.
2010;107(9):1058-70.

15. Prasad K, Dhar I. Oxidative stress as a
mechanism of added sugar-induced
cardiovascular disease. The International
journal of angiology: official publication of
the International College of Angiology, Inc.
2014;23(4):217.
16. Huynh K, Bernardo BC, McMullen JR,
Ritchie RH. Diabetic cardiomyopathy:
mechanisms and new treatment strategies
targeting antioxidant signaling pathways.
Pharmacology & therapeutics.
2014;142(3):375-415.
17. MacDonald MR, Petrie MC, Hawkins NM,
Petrie JR, Fisher M, McKelvie R, et al.
Diabetes, left ventricular systolic
dysfunction, and chronic heart failure.
European heart journal. 2008;29(10):1224-
40.
18. Poulsen MK, Henriksen JE, Dahl J,
Johansen A, Gerke O, Vach W, et al. Left
ventricular diastolic function in type 2
diabetes mellitus: prevalence and association
with myocardial and vascular disease.
Circulation Cardiovascular imaging.
2010;3(1):24-31.
19. Boonman-de Winter L, Rutten F, Cramer M,
Landman M, Liem A, Rutten G, et al. High
prevalence of previously unknown heart
failure and left ventricular dysfunction in
patients with type 2 diabetes. Diabetologia.
2012;55(8):2154-62.
20. Tadic M, Cuspidi C. The influence of type 2
diabetes on left atrial remodeling. Clinical
cardiology. 2015;38(1):48-55.
21. Group TS. Alterations in left ventricular, left
atrial, and right ventricular structure and
function to cardiovascular risk factors in
adolescents with type 2 diabetes
participating in the TODAY clinical trial.
Pediatric diabetes. 2015;16(1):39-47.
22. Armstrong AC, Gidding SS, Colangelo LA,
Kishi S, Liu K, Sidney S, et al. Association
of early adult modifiable cardiovascular risk
factors with left atrial size over a 20-year
follow-up period: the CARDIA study. BMJ
open. 2014;4(1):e004001.
23. Patel DA, Lavie CJ, Milani RV, Shah S,
Gilliland Y. Clinical implications of left
atrial enlargement: a review. The Ochsner
Journal. 2009;9(4):191-6.
24. Burnier M, Oparil S, Narkiewicz K,
Kjeldsen SE. New 2017 American Heart
Association and American College of
Cardiology guideline for hypertension in the
adults: major paradigm shifts, but will they
help to fight against the hypertension disease
burden? Blood pressure. 2018;27(2):62-5.
25. Association AD. Diagnosis and
classification of diabetes mellitus. Diabetes
care. 2014;37(Supplement 1):S81-S90.
26. Lang RM, Bierig M, Devereux RB,
Flachskampf FA, Foster E, Pellikka PA, et
al. Recommendations for chamber
quantification: a report from the American
Society of Echocardiography’s Guidelines
and Standards Committee and the Chamber
Quantification Writing Group, developed in
conjunction with the European Association
of Echocardiography, a branch of the
European Society of Cardiology. Journal of
the American Society of Echocardiography.
2005;18(12):1440-63.
27. Minamino-Muta E, Kato T, Morimoto T,
Taniguchi T, Inoko M, Haruna T, et al.
Impact of the left ventricular mass index on
the outcomes of severe aortic stenosis.
Heart. 2017:heartjnl-2016-311022.
28. Hashem MS, Kalashyan H, Choy J, Chiew
SK, Shawki AH, Dawood AH, et al. Left
ventricular relative wall thickness versus left
ventricular mass index in non-cardioembolic
stroke patients. Medicine. 2015;94(20):e872.
29. Blume GG, Mcleod CJ, Barnes ME, Seward
JB, Pellikka PA, Bastiansen PM, et al. Left
atrial function: physiology, assessment, and
clinical implications. European Journal of
Echocardiography. 2011;12(6):421-30.
30. Hee L, Nguyen T, Whatmough M, Descallar
J, Chen J, Kapila S, et al. Left atrial volume
and adverse cardiovascular outcomes in
unselected patients with and without CKD. Clinical Journal of the American Society of
Nephrology. 2014;9(8):1369-76.
31. Tsang TS, Abhayaratna WP, Barnes ME,
Miyasaka Y, Gersh BJ, Bailey KR, et al.
Prediction of cardiovascular outcomes with
left atrial size: is volume superior to area or
diameter? Journal of the American College
of Cardiology. 2006;47(5):1018-23.
32. Kurt M, Wang J, Torre-Amione G, Nagueh
SF. Left atrial function in diastolic heart
failure. Circulation: Cardiovascular Imaging.
2009;2(1):10-5.
33. Gulmez O, Parildar H, Cigerli O, Demirağ
N. Assessment of left atrial function in
patients with type 2 diabetes mellitus with a
disease duration of six months.
Cardiovascular journal of Africa.
2018;29(2):82-7.
34. Gulmez O, Parildar H, Cigerli O, Demirag
N. Assessment of Left Atrial Functions in
Patients with Prediabetes. Gen Med (Los
Angeles). 2017;5(296):2.
35. Zoppini G, Bonapace S, Bergamini C, Rossi
A, Trombetta M, Lanzoni L, et al. Evidence
of left atrial remodeling and left ventricular
diastolic dysfunction in type 2 diabetes
mellitus with preserved systolic function.
Nutrition, Metabolism and Cardiovascular
Diseases. 2016;26(11):1026-32.
36. Ayer JG, Almafragy HS, Patel AA, Hellyer
RL, Celermajer DS. Body mass index is an
independent determinant of left atrial size.
Heart, Lung and Circulation. 2008;17(1):19-
24.
37. Kadappu KK, Boyd A, Eshoo S, Haluska B,
Yeo AE, Marwick TH, et al. Changes in left
atrial volume in diabetes mellitus: more than
diastolic dysfunction? European Heart
Journal–Cardiovascular Imaging.
2012;13(12):1016-23.
38. Mondillo S, Cameli M, Caputo ML, Lisi M,
Palmerini E, Padeletti M, et al. Early
detection of left atrial strain abnormalities
by speckle-tracking in hypertensive and
diabetic patients with normal left atrial size.
Journal of the American Society of
Echocardiography. 2011;24(8):898-908.
39. Liu Y, Wang K, Su D, Cong T, Cheng Y,
Zhang Y, et al. Noninvasive assessment of
left atrial phasic function in patients with
hypertension and diabetes using
twodimensional speckle tracking and
volumetric parameters. Echocardiography.
2014;31(6):727-35.
40. Rohner A, Brinkert M, Kawel N, Buechel
RR, Leibundgut G, Grize L, et al. Functional
assessment of the left atrium by real-time
three-dimensional echocardiography using a
novel dedicated analysis tool: initial
validation studies in comparison with
computed tomography. European Journal of
Echocardiography. 2011;12(7):497-505.
41. Kataoka A, Funabashi N, Takahashi A,
Yajima R, Takahashi M, Uehara M, et al.
Quantitative evaluation of left atrial volumes
and ejection fraction by 320-slice computedtomography in comparison with three-and
two-dimensional echocardiography: a
single-center retrospective-study in 22
subjects. International journal of cardiology.
2011;153(1):47-54.
42. Vianna-Pinton R, Moreno CA, Baxter CM,
Lee KS, Tsang TS, Appleton CP. Twodimensional speckle-tracking
echocardiography of the left atrium:
feasibility and regional contraction and
relaxation differences in normal subjects.
Journal of the American Society of
Echocardiography. 2009;22(3):299-305.
43. Cameli M, Lisi M, Focardi M, Reccia R,
Natali BM, Sparla S, et al. Left atrial
deformation analysis by speckle tracking
echocardiography for prediction of
cardiovascular outcomes. The American
journal of cardiology. 2012;110(2):264-9.
44. Hirose T, Kawasaki M, Tanaka R, Ono K,
Watanabe T, Iwama M, et al. Left atrial
function assessed by speckle tracking
echocardiography as a predictor of newonset non-valvular atrial fibrillation: results

from a prospective study in 580 adults.
European Heart Journal–Cardiovascular
Imaging. 2011;13(3):243-50.
45. Shih J-Y, Tsai W-C, Huang Y-Y, Liu Y-W,
Lin C-C, Huang Y-S, et al. Association of
decreased left atrial strain and strain rate
with stroke in chronic atrial fibrillation.
Journal of the American society of
Echocardiography. 2011;24(5):513-9.
46. Otani K, Takeuchi M, Kaku K, Haruki N,
Yoshitani H, Tamura M, et al. Impact of
diastolic dysfunction grade on left atrial
mechanics assessed by two-dimensional
speckle tracking echocardiography. Journal
of the American Society of
Echocardiography. 2010;23(9):961-7.
47. Inoue T, Ogawa T, Iwabuchi Y, Otsuka K,
Nitta K. Left ventricular end-diastolic
diameter is an independent predictor of
mortality in hemodialysis patients.
Therapeutic apheresis and dialysis : official
peer-reviewed journal of the International
Society for Apheresis, the Japanese Society
for Apheresis, the Japanese Society for
Dialysis Therapy. 2012;16(2):134-41.
48. Silbiger JJ, Singh TK. Is Left Ventricular
End-Systolic Dimension a Reliable Predictor
of Postoperative Left Ventricular
Dysfunction in Patients with Mitral
Regurgitation Secondary to Mitral Valve
Prolapse? Journal of the American Society
of Echocardiography. 2016;29(2):181-2.
49. de Simone G, Gottdiener JS, Chinali M,
Maurer MS. Left ventricular mass predicts
heart failure not related to previous
myocardial infarction: the Cardiovascular
Health Study. European heart journal.
2008;29(6):741-7.
50. From AM, Scott CG, Chen HH. Changes in
diastolic dysfunction in diabetes mellitus
over time. The American journal of
cardiology. 2009;103(10):1463-6.