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SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 15 NUMBER 1 • JULY 2018
23
Assessment of left atrial function in patients with type 2
diabetes mellitus with a disease duration of six months
Oyku Gulmez, Hulya Parildar, Ozlem Cigerli, Nilgun Demira
ğ
Correspondence to: Oyku Gulmez
Department of Cardiology, Baskent University, Istanbul Medical and
Research Centre, Istanbul, Turkey
email:
gulmezoyku@yahoo.comHulya Parildar, Ozlem Cigerli
Department of Anaesthesia, University College Hospital, College of
Medicine, University of Ibadan, Ibadan, Nigeria
Nilgun Demira
ğ
Department of Anaesthesia, University College Hospital, College of
Medicine, University of Ibadan, Ibadan, Nigeria
Previously published in
Cardiovasc J Afr
2018;
29
: 82–87
S Afr J Diabetes Vasc Dis
2018;
15
: 23–28
Abstract
Introduction:
Changes in left atrial (LA) size and function are
associated with adverse clinical events. Recently, duration
of diabetes mellitus (DM2) has been found to be positively
associated with increased LA volume and impaired LA
function. This study was performed, using two-dimensional
echocardiograpy, to evaluate the changes in LA volume and
function in patients with DM2 with a disease duration of six
months, and to assess the parameters that affect LA volume
and function.
Methods:
Fifty-six patients (28 male, age: 52.6 ± 6.5 years)
with DM2 and 56 controls (24male; age: 50.1 ± 7.0 years) were
enrolled in the study. Each subject underwent conventional
two-dimensional echocardiography to assess LA volume
(indexed maximal LA volume: Vmax, pre-atrial contraction
volume: Volp, minimal LA volume: Vmin) and LA function
[passive emptying volume – passive emptying fraction (PEV
– PEF), active emptying volume – active emptying fraction
(AEV – AEF), total emptying volume – total emptying fraction
(TEV – TEF)].
Results:
LA diameter, indexed Vmax, Volp, Vmin, AEV and
TEV were found to be significantly higher in the DM2 group
compared with the controls (
p
< 0.05). Indexed Vmax, Volp
and Vmin were significantly correlated with HbA
1c
level,
body mass index (BMI), high-sensitivity C-reactive protein
and uric acid levels, mitral A wave, E/E’ ratio and A’ wave.
According to multivariate analysis, age and BMI had a
statistically significant effect on LA volume.
Conclusion:
Impaired LA function may be present in patients
with newly diagnosed DM2. BMI and increasing age caused
LA enlargement and LA volumes that were independent of
the effects of hypertension and DM2.
Keywords:
left atrial volume, left atrial function, diabetes melli-
tus, transthoracic echocardiography
The prevalence of type 2 diabetes mellitus (DM2) increases over
a person’s lifetime due to aging, the epidemic of obesity and
sedentary lifestyles. Moreover, the incidence of cardiovascular
disease (CVD), and morbidity and mortality due to CVD increase in
patients with DM2.
1,2
Early changes in left ventricular (LV) function in patients with
DM2 have been extensively investigated, however, assessment of
left atrial (LA) function is of growing interest.
2-8
The left atrium
serves as a reservoir during ventricular systole, as a conduit during
early diastole, and as an active contractile chamber that augments
LV filling in late diastole.
Total emptying volume (TEV) describes LA reservoir function,
passive emptying volume (PEV) describes LA conduit function, and
active emptying volume (AEV) describes LA booster pump function.
7,9
Two-dimentional (2D) echocardiography is a non-invasive, easy-to-
use and accessible method to evaluate LA volume and function.
Several studies have shown that changes in LA size and function
were associated with adverse clinical events such as atrial fibrillation,
stroke, diastolic dysfunction and LV failure.
10-13
Moreover, studies that evaluated LA volume and function in
patients with DM2 showed that LA volume and function were
independent predictors of cardiovascular events.
4-8
Recently,
the duration of DM2 disease has been found to be strongly and
positively associated with larger LA volume and impaired LA
function measured by echocardiography.
14
The aims of our study were to evaluate the change in LA volume
and function, and assess the parameters that affect LA volume
and function in patients with DM2 with a disease duration of six
months, using 2D echocardiograpy.
Methods
Fifty-six patients (28 male, mean age 52.6 ± 6.5 years) with DM2,
according to the American Diabetes Association (ADA) 2013 criteria,
with a disease duration of a maximum of six months (recruited
from the endocrinology and metabolism departments) and 56 age-
matched healthy volunteers (24 male, mean age 50.1 ± 7.0 years)
(recruited from the cardiology department) were included in the
study.
15
A detailed medical history, physical examination and 12-lead
electrocardiography were obtained from the study population.
All subjects underwent a treadmill exercise test according to the
Bruce protocol, or myocardial perfusion scintigrapyh to rule out
latent ischaemia. Patients with evidence of ischaemia, arrhythmia
on an electrocardiogram (ECG), LV dysfunction with an ejection
fraction (EF) of < 50%, significant valvular disease, history of
coronary artery disease, suspicion of secondary hypertension,
uncontrolled hypertension, thyroid disorder, pulmonary disease and
renal failure (defined as decreased glomerular filtration rate of < 60
ml/min/1.73 m
2
for at least three months), type 1 DM, electrolyte
imbalance, and technically insufficient echocardiographic and
electrocardiographic data were excluded.
The local ethics committee approved the study. All participants
provided written, informed consent prior to participation in the
study.