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SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 15 NUMBER 1 • JULY 2018
25
Table 1.
Demographic characteristics and laboratory parameters of the
groups
Control group DM2 group
Characteristics
(
n
= 56)
(
n
= 56)
p
-value
Age, years
50.1 ± 7.0
52.6 ± 6.5
0.06
Male,
n
(%)
24 (42.9)
28 (50)
0.55
BMI (kg/m
2
)
22.5 ± 2.0
28.0 ± 4.9
< 0.001
Tobacco use,
n
(%)
9 (16.1)
8 (14.3)
1.00
Hypertension,
n
(%)
6 (10.7)
44 (78.6)
< 0.001
Hyperlipidaemia,
n
(%)
11 (19.6)
47 (83.9)
< 0.001
Medication,
n
(%)
ACE inhibitors
5 (8.9)
40 (71.4)
Beta-blockers
1 (1.8)
16 (28.6)
Statins
5 (8.9)
36 (64.3)
ASA
37 (66.1)
3 (5.4)
Insulin and OAD
33 (58.9)
Fasting glucose (mg/dl)
93.9 ± 6.4
153.0 ± 67.0
< 0.001
(mmol/l)
(5.21 ± 0.36)
(8.49 ± 3.72)
HbA
1c
(%)
4.8 ± 0.6
8.1 ± 1.9
< 0.001
Total cholesterol (mg/dl)
211.4 ± 39.7 225.3 ± 50.6
0.11
(mmol/l)
(5.48 ± 1.03)
(5.84 ± 1.31)
HDL-C (mg/dl)
48.2 ± 12.5
45.4 ± 8.5
0.16
(mmol/l)
(1.25 ± 0.32)
(1.18 ± 0.22)
LDL-C (mg/dl)
132.9 ± 38.2 140.1 ± 40.7
0.34
(mmol/l)
(3.44 ± 0.99)
(3.63 ± 1.05)
TG (mg/dl)
141.0 ± 84.7 190.4 ± 105.0
0.01
(mmol/l)
(1.59 ± 0.96)
(2.15 ± 1.19)
hsCRP (mg/l)
1.9 ± 1.2
5.3 ± 2.9
< 0.001
Uric acid (mg/dl)
4.6 ± 1.0
6.2 ± 1.6
< 0.001
DM: diabetes mellitus, BMI: body mass index, ACE: angiotensin converting
enzyme, ASA: acetylsalisilic asid, OAD: oral antidiabetics, HbA
1c
: glycosylated
haemoglobin, HDL-C: high-density lipoprotein cholesterol, LDL-C: low-density
lipoprotein cholesterol, TG: triglycerides, hsCRP: high-sensitivity C-reactive
protein.
Table 2.
Echocardiographic parameters of the study groups
Control group DM2 group
Parameters
(
n
= 56)
(
n
= 56)
p
-value
EF (%)
61.9 ± 5.0
60.6 ± 4.4
0.14
Left ventricular mass (g/m
2
)
93.2 ± 8.4
102.3 ± 8.0 < 0.001
Mitral E (cm/s)
79.1 ± 14.1 81.2 ± 16.7
0.47
Mitral A (cm/s)
66.4 ± 13.2 80.8 ± 18.8 < 0.001
E/A ratio (cm/s)
1.2 ± 0.3
1.2 ± 0.9
0.68
Deceleration time (s)
199.0 ± 17.9 222.8 ± 19.7 < 0.001
Mitral E’ (cm/s)
18.5 ± 4.3
15.3 ± 3.3 < 0.001
Mitral A’ (cm/s)
14.0 ± 3.2
16.1 ± 5.0
0.011
E/E’ ratio (cm/s)
4.4 ± 1.0
5.5 ± 1.7 < 0.001
Diastolic dysfunction,
n
(%)
12 (21.4)
29 (51.8)
0.002
DM: diabetes mellitus; EF: ejection fraction.
Table 3.
The echocardiographic parameters for the LA function of the
study groups
Hypertensives Controls
Parameter (
n
= 140) (
n
= 70)
p
-value
Mean sodium (mmol/l) 135.9 ± 4.7 133.7 ± 2.4
> 0.05
Mean potassium (mmol/l) 3.8 ± 0.5
3.1 ± 0.4
< 0.05*
Mean urea (mmol/l)
5.8 ± 2.2
3.2 ± 1.7
> 0.05
Mean creatinine (μmol/l)
84.2 ± 12.6
68.4 ± 10.8
> 0.05
Mean FBS (mmol/l)
5.6 ± 1.9
4.0 ± 1.3
< 0.005*
Mean LDL-C (mmol/l)
2.49 ± 1.41
2.35 ± 0.63
> 0.05
Mean HDL-C (mmol/l)
1.06 ± 0.36
1.29 ± 0.46
< 0.05*
Mean TG (mmol/l)
1.33 ± 0.59
1.18 ± 0.41
> 0.05
Mean TC (mmol/l)
4.84 ± 1.69
4.23 ± 1.29
> 0.05
DM: diabetes mellitus, LA: left atrium, PEV: passive emptying volume, AEV:
active emptying volume, TEV: total emptying volume.
Table 4.
Comparison of echocardiographic parameters regarding
diastolic dysfunction for the LA function in the DM2 group
Diastolic
Diastolic
dysfunction (+)
dysfunction (–)
Parameters
(
n
= 29)
(
n
= 27)
p
-value
LA diameter (mm)
37.4 ± 5.1
36.5 ± 5.8
0.548
Indexed V
max
(ml/m²)
25.8 ± 6.9
23.5 ± 6.2
0.196
Indexed V
olp
(ml/m²)
18.1 ± 5.8
16.1 ± 4.7
0.168
Indexed V
min
(ml/m²)
10.8 ± 4.6
9.2 ± 3.7
0.168
Indexed PEV (ml/m²)
7.6 ± 3.2
7.3 ± 3.4
0.735
Indexed AEV (ml/m²)
7.3 ± 2.8
6.8 ± 2.6
0.555
Indexed TEV (ml/m²)
14.9 ± 4.1
14.2 ± 4.0
0.505
LA passive emptying
fraction (%)
29.5 ± 10.9
30.5 ± 11.5
0.751
LA active emptying
fraction (%)
41.1 ± 11.1
43.0 ± 12.7
0.541
LA total emptying
fraction (%)
58.7 ± 9.8
60.9 ± 9.4
0.402
DM: diabetes mellitus, LA: left atrium, PEV: passive emptying volume, AEV:
active emptying volume, TEV: total emptying volume.
To determine the influential factors for LA volume, we examined
the potential variables that we thought to be echocardiographically
and clinically relevant: mitral A wave, E’ wave, A’ wave, E/E’ ratio,
BMI, and fasting glucose, HbA
1c
, hsCRP and uric acid levels. There
were weak positive correlations between all indexed LA volumetric
parameters and all the variables except for indexed PEV and BMI,
fasting glucose, HbA
1c
, hsCRP and uric acid levels, mitral A wave,
E/E’ ratio and mitral A’ wave. There was a weak negative correlation
between all indexed LA volumetric parameters and all the variables
except indexed PEV and mitral E’ wave (Table 5).
Univariate analysis showed that DM2, hypertension, age,
BMI, and hsCRP and uric acid levels had a statistically significant
impact on LA diameter, and indexed Vmax, Volp, Vmin, AEV
and TEV. According to multivariate analysis when adjusted with
other confounders, hypertension, age and BMI had a statistically
significant effect on LA diameter; age and BMI had a statistically
significant effect on indexed Vmax; age, BMI and uric acid level
had a statistically significant effect on indexed Volp; uric acid level
had a statistically significant effect on indexed Vmin; age had a
statistically significant effect on indexed AEV; and age and BMI had
a statistically significant effect on indexed TEV (Table 6).
Discussion
Diabetes mellitus can lead to changes in LA volume and function.
In most studies, LA function is determined by performing real-
time three-dimensional (3D) echocardiography, cardiac magnetic
resonance imaging (CMRI), and strain and strain rate tests.
However, in general practice, LA function can be easily and non-
invasively determined by performing 2D echocardiography. In our
study, we showed that even if LA size and volume were within
normal limits, LA dysfunction may be present in patients with DM2
who was diagnosed in the preceding six months, and this finding
was mainly due to BMI and age.