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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018
82
AFRICA
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
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 asso-
ciated with increased LA volume and impaired LA function.
This study was performed, using two-dimensional echocardi-
ograpy, 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 (24 male; 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: V
max
, pre-atrial contraction volume: V
olp
,
minimal LA volume: V
min
) and LA function [passive empty-
ing 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 V
max
, V
olp
, V
min
, AEV and TEV
were found to be significantly higher in the DM2 group
compared with the controls (
p
<
0.05). Indexed V
max
, V
olp
and
V
min
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 signifi-
cant 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
Submitted 25/5/17, accepted 7/11/17
Published online 30/11/17
Cardiovasc J Afr
2017;
29
: 82–87
www.cvja.co.zaDOI: 10.5830/CVJA-2017-048
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
Department of Cardiology, Baskent University, Istanbul
Medical and Research Centre, Istanbul, Turkey
Oyku Gulmez, MD,
gulmezoyku@yahoo.comDepartment of Family Medicine, Baskent University,
Istanbul Medical and Research Centre, Istanbul, Turkey
Hulya Parildar, MD
Ozlem Cigerli, MD
Department of Endocrinoloy and Metabolism, Baskent
University, Istanbul Medical and Research Centre, Istanbul,
Turkey
Nilgun Demira
ğ
, MD