Cardiovascular Journal of Africa: Vol 29 No 2 (March/April 2018)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 2, March/April 2018 84 AFRICA
groups, there were no significant differences in indexed PEV,
AEF and TEF (p > 0.05) (Table 3).
Patients in the DM2 group were divided according to
presence of diastolic dysfunction. There were no significant
differences within the DM2 group regarding LA volume and
function (p > 0.05) (Table 4).
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, HbA1c,
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,
HbA1c, 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
Table 1. Demographic characteristics and
laboratory parameters of the groups
Characteristics
Control group
(n = 56)
DM2 group
(n = 56) p-value
Age, year 50.1 ± 7.0 52.6 ± 6.5 0.06
Male, n (%) 24 (42.9) 28 (50) 0.55
BMI (kg/m2 ) 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)
HbA1c (%) 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, HbA1c: glycosylated
haemoglobin, HDL-C: high-density lipoprotein cholesterol, LDL-C: low-densi-
ty lipoprotein cholesterol, TG: triglycerides, hsCRP: high-sensitivity C-reactive
protein.
Table 2. Echocardiographic parameters of the study groups
Parameters
Control group
(n = 56)
DM2 group
(n = 56) p-value
EF (%) 61.9 ± 5.0 60.6 ± 4.4 0.14
Left ventricular mass (g/m2) 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
Parameters
Control group
(n = 56)
DM2 group
(n = 56) p-value
LA diameter (mm) 33.3 (26–46) 37.5 (27–56) < 0.001
Indexed Vmax (ml/m²) 19.8 ± 4.6 24.8 ± 6.6 < 0.001
Indexed Volp (ml/m²) 11.8 (4.6–23.6) 16.1 (9.5–30) < 0.001
Indexed Vmin (ml/m²) 7.2 (2.8–14.0) 9.5 (3.8–24.5) < 0.001
Indexed PEV (ml/m²) 7.4 ± 3.4 7.5 ± 3.2 0.66
Indexed AEV (ml/m²) 5.0 (0.7–16.4) 6.6 (2.4–15.1) < 0.001
Indexed TEV (ml/m²) 12.5 ± 3.7 14.6 ± 4.1 0.004
LA passive emptying fraction (%) 35.5 ± 14.4 30.0 ± 11.1 0.003
LA active emptying fraction (%) 39.9 ± 13.5 42.0 ± 11.8 0.386
LA total emptying fraction (%) 60 (33.8–76.1) 63.9 (29.0–81.8) 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
Parameters
Diastolic
dysfunction (+)
(n = 29)
Diastolic
dysfunction (–)
(n = 27) p-value
LA diameter (mm) 37.4 ± 5.1 36.5 ± 5.8 0.548
Indexed Vmax (ml/m²) 25.8 ± 6.9 23.5 ± 6.2 0.196
Indexed Volp (ml/m²) 18.1 ± 5.8 16.1 ± 4.7 0.168
Indexed Vmin (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.