Left atrial strain and diastolic function abnormalities in obese and type 2 diabetic adolescents and young adults

Abstract

Background Adults with obesity and type 2 diabetes mellitus (T2DM) related to obesity are at increased risk of heart failure with preserved ejection fraction (HFpEF). Whether left ventricular (LV) diastolic function abnormalities related to obesity and T2DM start in adolescence and early adulthood is unknown. We non-invasively evaluated the differences seen in LV diastolic and left atrial (LA) function in adolescents and young adults with obesity and T2DM. Methods We analyzed echocardiographic measures of LV diastolic function in patients with structurally normal hearts which were divided into 3 groups (normal weight, obese, and T2DM). Spectral and tissue Doppler and 2-D speckle tracking measurements of diastolic function were obtained. Logistic regression was performed to compare the prevalence of abnormalities in diastolic function based on the worst 25th percentile for each measure to determine the prevalence of diastolic and LA function abnormalities in obese and T2DM patients. Results 331 teenagers and young adults (median age 22.1 years) were analyzed (101 normal weight, 114 obese, 116 T2DM). Obese and T2DM group had lower E/A and higher E/e′. Obese and T2DM patients had significantly lower atrial reservoir, conduit, and booster strain and worse reservoir and conduit strain rate compared to normal patients (p < 0.001 for all measures). All patients had normal LA volumes. On multivariable analysis, conduit strain and reservoir and conduit strain rate were independently associated with having below the 25th percentile e′. Conduit strain rate was independently associated with having below the 25th percentile for mitral E/A ratio on multivariable analysis. Conclusions Abnormal indices of LV diastolic function are detected in adolescents and young adults with obesity and T2DM. LA function and strain analysis were able to detect evidence of decreased reservoir, conduit, and booster strain in these patients although LA volume was normal. The use of LA function strain may increase our ability to detect early diastolic function abnormalities in this population.

Impact of insulin resistance on subclinical left ventricular dysfunction in normal weight and overweight/obese japanese subjects in a general community

“…DM causes LV dysfunction even without overt coronary artery disease (i.e. diabetic cardiomyopathy), leading to higher incidence of HF compared with non-diabetic individuals [ 2 – 7 ]. Moreover, recent population-based studies showed significantly elevated risk of HF in non-diabetic individuals with insulin resistance [ 13 – 16 ].…”

“…DM causes atherosclerotic cardiovascular disease and subsequent left ventricular (LV) dysfunction. Furthermore, DM per se may cause myocardial impairment known as “diabetic cardiomyopathy”, leading to two to fourfold increased risk of heart failure (HF) compared with nondiabetic individuals [ 2 – 7 ]. Given the unfavorable outcomes and enormous economic burden, early identification of individuals at higher risk for HF and timely therapeutic intervention is of crucial importance.…”

A cross sectional study to compare cardiac structure and diastolic function in adolescents and young adults with youth-onset type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth Study

“…As abnormal geometry is virtually never seen in healthy individuals [ 11 , 35 , 39 ], these findings suggest risk of subclinical cardiac abnormalities in both forms of diabetes. Higher rates of abnormal cardiac geometry in type 2 diabetes are likely due to combined obesity and diabetes as cardiac remodeling is seen in obese youth without diabetes [ 11 , 13 ].…”

“…Prior work has demonstrated antecedents/risk factors of HFpEF particularly elevated left ventricular (LV) mass, lower diastolic function, and higher left atrial size are present in adolescents and young adults with type 2 diabetes higher relative to obese controls [ 11 – 13 ]. In separate studies of youth with type 1 diabetes, higher LV mass and worse diastolic function have been described [ 14 – 17 ].…”

Uso da vitamina D para a diminuição do risco cardiovascular em pacientes com diabetes mellitus tipo II: Uma Revisão Sistemática

“…A DM2 é frequentemente associada a outras patologias ou complicações, sendo apontada como fator capaz de ocasionar e agravar doenças cardiovasculares ateroscleróticas e, por consequência, provocar problemas cardíacos graves. Nesse sentido, também pode ser um fator preditor para o comprometimento miocárdico conhecido como cardiomiopatia diabética, tendo por consequência um risco duas a quatro vezes maior de insuficiência cardíaca (IC) em comparação com indivíduos não diabéticos (Sharma et al, 2018;Steele et al, 2020).…”