The Influence of Type 2 Diabetes on Left Atrial Remodeling

Abstract

The influence of type 2 diabetes mellitus on cardiac remodeling has been evaluated for decades; however, the majority of investigations were focused only on the left ventricle. The impact of diabetes on the left atrial (LA) function is less researched. LA enlargement has been shown as an independent predictor of cardiovascular morbidity and mortality in the general and diabetic population; however, LA dysfunction has been proven to be an independent predictor only in the general population. There are not much follow-up data about the influence of diabetes on LA function. New echocardiographic techniques, such as 2-dimensional speckle tracking imaging, provide more accurate, sensitive, and reliable information about LA function than traditional, volumetric methods. The aim of this review was to summarize the most recent reports about the influence of diabetes on LA function, as well as to discuss the possible mechanisms and potential clinical implications of the relationship between diabetes and LA remodeling.

Relationship between increased left atrial volume and microvascular complications in patients with type 2 diabetes

“…In recent years, however, there has been a growing scientific interest in exploring the functional and structural changes of the LA as well as the prognostic impact of LA enlargement on CVD outcomes in this patient population (Kadappu et al, 2012;Poulsen et al, 2013;Tadic & Cuspidi, 2015).…”

Assessment of Left Atrial Functions in Patients with Prediabetes

“…Assessment of LA volumes and functions is a growing interest since changes in LA size and functions are associated with CVE such as atrial fibrillation, stroke, diastolic dysfunction and LV failure in general and diabetic population [9][10][11][12][13][14][15][16][17]. 2D echocardiography derived LA volume provides more accurate assessment of LA size because of the irregular geometry of LA as it often enlarges asymmetrically, resulting in variable shape that may underestimate LA size [6]. Cardiovascular imaging modalities for determination of LA functions like computed tomography (CT), cardiac magnetic resonance imaging (CMRI), and 3D echocardiography are still evolving.…”

“…Cardiovascular imaging modalities for determination of LA functions like computed tomography (CT), cardiac magnetic resonance imaging (CMRI), and 3D echocardiography are still evolving. Although the main advantage of CMRI and CT over echocardiography is determination of all parts of LA, including LA appendage, usage of iodine and radiation during CT, and usefulness of CMRI in patients with pacemakers limit their usage [6]. Therefore, we preferred to use 2D echocardiography which is a non-invasive, easy applicable and accessible method to evaluate LA volumes and functions.…”

“…Moreover, Kadappu et al reported that LA dilatation in DM was independent of associated hypertension and diastolic dysfunction which was called atrial cardiomyopathy [8]. Atrial structural and functional remodeling in DM can be explained with several mechanisms: LV diastolic dysfunction, oxidative stress, and inflammation, autonomic nervous system disbalance with enhanced sympathetic activation, increased blood pressure, and subendocardial fibrosis [6]. Recently Gudul et al reported that LA diameter; LA AEV and LA AEF were significantly higher in preDM group than control group [22].…”

“…Moreover, preDM is associated with left ventricular (LV) structure abnormalities and diastolic dysfunction even in the presence of normal systolic function in patients without coronary artery disease [3][4][5]. Assessment of left atrium (LA) functions is a groving interest as LA serves as a reservoir during ventricular systole, as a conduit during early diastole, and as an active contractile chamber that augment left ventricular filling in late diastole [6,7]. Recently published trial by Kadappu et al demonstrated that LA dilatation and dysfunction may be a coexistent diastolic dysfunction marker in patients with DM [8].…”