Three-Dimensional Echocardiography in Evaluating LA Volumes and Functions in Diabetic Normotensive Patients without Symptomatic Cardiovascular Disease

Abstract

Background. Cardiovascular complications are the most serious threat to diabetic patients. Associated metabolic and microvascular changes are the main cause of cardiac function affection, and the earliest cardiac change is diastolic dysfunction. Assessment of LA function changes is a key to determine early heart damage of diabetic patients. Objectives. To evaluate the effect of diabetes mellitus on left atrial volumes and functions by using real-time 3-dimensional echocardiography in normotensive patients free from cardiovascular disease. Methods. The study included 110 individuals, 50 controls and 60 patients with diabetes mellitus, 30 patients with type 1 diabetes mellitus and 30 patients with type 2 diabetes mellitus. 2-dimensional echocardiography was used to assess the LA maximum volume and LA phasic volumes, and LA maximum volume indexed to body surface area were measured by 3D echocardiography. LA functions (LA total stroke volume, LA active stroke volume, and LA active emptying fraction) were obtained from RT3D volumetric analysis. Results. The results of the analysis revealed that type 2 diabetes mellitus showed enlarged Vmax, Vmin, and LAVi with an increased LA total stroke volume and decreased active emptying fraction, while type 1 diabetics showed only decreased in active emptying fraction. The LA maximum volume indexed to body surface area (LAVi) was significantly higher in type 2 diabetic patients as compared to normal controls which was 23.55±3.37 ml/m2 versus 20.30. Conclusion. Patients with type 2 diabetes mellitus have an increased LA volume with impaired compliance and contractility, while patients with type 1 diabetes mellitus have only impaired contractility compared to nondiabetic subjects.

Association of Left Atrial Size Measured by Non-Contrast Computed Tomography with Cardiovascular Risk Factors—The Danish Cardiovascular Screening Trial (DANCAVAS)

“…A similar paradoxical correlation was found for diabetes and dyslipidaemia. The negative association between HbA1c level and LA size in men, conflicts with current literature [32,33]. These two papers [32,33] are case-control studies including 40 and 60 patients with diabetes, respectively, and they are based on echocardiographic measurements, thus with a risk confirmation bias.…”

“…The negative association between HbA1c level and LA size in men, conflicts with current literature [32,33]. These two papers [32,33] are case-control studies including 40 and 60 patients with diabetes, respectively, and they are based on echocardiographic measurements, thus with a risk confirmation bias. The effect of diabetes on atrial size could be reduced when indexing LA size to body size, which is a major contributor to diabetes.…”

A Preliminary Study of Left Atrial Function and Left Atrial Stiffness in Type 2 Diabetic Patients with Normotensive Patients Without Symptomatic Cardiovascular Disease

“…Previous studies have con rmed that LA function is impaired and left atrial volume is increased in DM2 patients with normal blood pressure and asymptomatic cardiovascular disease. Although the mechanism of this damage is unclear, atrial myocardial damage caused by persistent hyperglycemia and LA brosis has been considered to be a pathogenic factor [16,17]. Compared with the control group, the left atrial volume index of DM2 patients increased, the difference was statistically signi cant, while the LAAD value of the two groups changed little, the difference was not statistically signi cant.…”