Left atrial function in diabetes: does it help?

Acta Diabetologica volume 58, pages131–137(2021)Cite this article

Abstract

Left atrial (LA) structural, functional and mechanical changes have important role in development of diabetic cardiomyopathy and it was discovered that LA remodeling has important prognostic role in the patients with diabetes (DM). Previously the focus of echocardiographic studies in DM population was on the left ventricular structure and function, but the atrioventricular coupling was proved to be one of the main predictors of cardiovascular morbidity and mortality in DM patients. Each phase of LA cycle has determinant role in the atrioventricular coupling and therefore the accurate assessment of LA phasic function gained importance over last decade. The failure of any of the three LA phasic functions (reservoir, conduit or contractile) leads potentially to LA dilatation, left ventricular diastolic dysfunction, atrial fibrillation and ultimately development of heart failure with preserved (or even reduced) ejection fraction. Even though LA phasic function has not been extensively studied in DM population, it is reasonable to hypothesize that LA dysfunction is very frequent in these patients, considering the high prevalence of atrial fibrillation and heart failure in these individuals. In research and clinical purposes two techniques have been used for determination of LA phasic function: volumetric and strain. Although these methods fundamentally differ, with their own advantages and limitations, they also provide comparable results that can direct our therapeutic approach in DM patients. Namely, not only that LA function represents an independent predictor of cardiovascular outcome in DM patients, but also it has been also associated with parameters of glycemic control. This review summarized the current knowledge regarding LA phasic function in DM patients.

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References

  1. 1.

    Mondillo S, Cameli M, Caputo ML et al (2011) Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr 24(8):898–908

    PubMed  Article  PubMed Central  Google Scholar 

  2. 2.

    Antoni ML, Ten Brinke EA, Marsan NA, Atary JZ, Holman ER, van der Wall EE et al (2011) Comprehensive assessment of changes in left atrial volumes and function after ST-segment elevation acute myocardial infarction: role of two-dimensional speckle-tracking strain imaging. J Am Soc Echocardiogr 24:1126–1133

    PubMed  Article  PubMed Central  Google Scholar 

  3. 3.

    Obokata M, Negishi K, Kurosawa K, Arima H, Tateno R, Ui G et al (2013) Incremental diagnostic value of la strain with leg lifts in heart failure with preserved ejection fraction. JACC Cardiovasc Imaging 6:749–758

    Article  Google Scholar 

  4. 4.

    Hoit BD (2014) Left atrial size and function: role in prognosis. J Am Coll Cardiol 63:493–505

    Article  PubMed  Google Scholar 

  5. 5.

    Obokata M, Negishi K, Kurosawa K, Tateno R, Tange S, Arai M et al (2014) Left atrial strain provides incremental value for embolism risk stratification over CHA(2)DS(2)-VASc score and indicates prognostic impact in patients with atrial fibrillation. J Am Soc Echocardiogr 27(709–16):e4

    Google Scholar 

  6. 6.

    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39

    PubMed  Article  PubMed Central  Google Scholar 

  7. 7.

    Nagueh SF, Smiseth OA, Appleton CP et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17(12):1321–1360

    Article  PubMed  Google Scholar 

  8. 8.

    Pieske B, Tschöpe C, de Boer RA et al (2019) How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J 40(40):3297–3317

    PubMed  Article  PubMed Central  Google Scholar 

  9. 9.

    Rønningen PS, Berge T, Solberg MG, Enger S, Nygard S, Pervez MO et al (2020) Sex differences and higher upper normal limits for left atrial end-systolic volume in individuals in their mid-sixties: data from the ACE 1950 study. Eur Heart J Cardiovasc Imaging. 21:501–507

    PubMed  Article  PubMed Central  Google Scholar 

  10. 10.

    Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107–133

    PubMed  Article  PubMed Central  Google Scholar 

  11. 11.

    Iguchi Y, Kimura K, Aoki J et al (2008) Prevalence of atrial fibrillation in community-dwelling Japanese aged 40 years or older in Japan: analysis of 41,436 non-employee residents in Kurashiki-city. Circ J 72:909–913

    PubMed  Article  PubMed Central  Google Scholar 

  12. 12.

    Nichols GA, Hillier TA, Erbey JR, Brown JB (2001) Congestive heart failure in type 2 diabetes: prevalence, incidence and risk factors. Diabetes Care 24:1614–1619

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  13. 13.

    Polovina M, Lund LH, Đikić D et al (2020) Type 2 diabetes increases the long-term risk of heart failure and mortality in patients with atrial fibrillation. Eur J Heart Fail 22(1):113–125

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  14. 14.

    Chirinos JA, Sardana M, Ansari B et al (2018) Left atrial phasic function by magnetic resonance feature tracking is a strong predictor of incident cardiovascular events. Circ Cardiovasc Imaging 11(12):e007512

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Tadic M, Cuspidi C (2015) The influence of type 2 diabetes on left atrial remodeling. Clin Cardiol 38(1):48–55

    PubMed  Article  PubMed Central  Google Scholar 

  16. 16.

    Zoppini G, Bonapace S, Bergamini C et al (2016) Evidence of left atrial remodeling and left ventricular diastolic dysfunction in type 2 diabetes mellitus with preserved systolic function. Nutr Metab Cardiovasc Dis 26(11):1026–1032

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Atas H, Kepez A, Atas DB et al (2014) Effects of diabetes mellitus on left atrial volume and functions in normotensive patients without symptomatic cardiovascular disease. J Diabetes Complicat 28(6):858–862

    Article  Google Scholar 

  18. 18.

    Cameli M, Mandoli GE, Lisi E et al (2019) Left atrial, ventricular and atrio-ventricular strain in patients with subclinical heart dysfunction. Int J Cardiovasc Imaging 35(2):249–258

    PubMed  Article  Google Scholar 

  19. 19.

    Liu Y, Wang K, Su D et al (2014) Noninvasive assessment of left atrial phasic function in patients with hypertension and diabetes using two-dimensional speckle tracking and volumetric parameters. Echocardiography 31(6):727–735

    PubMed  Article  PubMed Central  Google Scholar 

  20. 20.

    Bohne LJ, Johnson D, Rose RA, Wilton SB, Gillis AM (2019) The association between diabetes mellitus and atrial fibrillation: clinical and mechanistic insights. Front Physiol 10:135

    PubMed  PubMed Central  Article  Google Scholar 

  21. 21.

    Masuda T, Muto S, Fujisawa G et al (2012) Heart angiotensin II-induced cardiomyocyte hypertrophy suppresses coronary angiogenesis and progresses diabetic cardiomyopathy. Am J Physiol Heart Circ Physiol. 302(9):H1871–H1883

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  22. 22.

    Kassan M, Choi SK, Galán M et al (2013) Enhanced NF-κB activity impairs vascular function through PARP-1-, SP-1-, and COX-2-dependent mechanisms in type 2 diabetes. Diabetes 62:2078–2087

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  23. 23.

    Ritchie RH, Abel ED (2020) Basic mechanisms of diabetic heart disease. Circ Res 126(11):1501–1525

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  24. 24.

    Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP (2019) Left atrial structure and function, and left ventricular diastolic dysfunction: JACC State-of-the-Art Review. J Am Coll Cardiol 73(15):1961–1977

    PubMed  Article  PubMed Central  Google Scholar 

  25. 25.

    Hoit BD (2014) Left atrial size and function: role in prognosis. J Am Coll Cardiol 63(6):493–505

    Article  PubMed  Google Scholar 

  26. 26.

    Hoit BD (2018) Assessment of left atrial function by echocardiography: novel insights. Curr Cardiol Rep 20(10):96

    PubMed  Article  PubMed Central  Google Scholar 

  27. 27.

    Levy F, Iacuzio L, Schouver ED et al (2019) Performance of a new fully automated transthoracic three-dimensional echocardiographic software for quantification of left cardiac chamber size and function: comparison with 3 Tesla cardiac magnetic resonance. J Clin Ultrasound 47(9):546–554

    PubMed  Article  PubMed Central  Google Scholar 

  28. 28.

    Cameli M, Mandoli GE, Loiacono F, Dini FL, Henein M, Mondillo S (2016) Left atrial strain: a new parameter for assessment of assessment of left ventricular filling pressure. Heart Fail Rev 21(1):65–76

    PubMed  Article  PubMed Central  Google Scholar 

  29. 29.

    Cameli M, Lisi M, Mondillo S, Padeletti M, Ballo P, Tsioulpas C, Bernazzali S, Maccherini M (2010) Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure. Cardiovasc Ultrasound 8:14

    PubMed  PubMed Central  Article  Google Scholar 

  30. 30.

    Cameli M, Sparla S, Losito M et al (2016) Correlation of left atrial strain and Doppler measurements with invasive measurement of left ventricular end-diastolic pressure in patients stratified for different values of ejection fraction. Echocardiography 33(3):398–405

    PubMed  Article  PubMed Central  Google Scholar 

  31. 31.

    Modin D, Biering-Sørensen SR, Møgelvang R, Alhakak AS, Jensen JS, Biering-Sørensen T (2019) Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population. Eur Heart J Cardiovasc Imaging 20(7):804–815

    PubMed  Article  PubMed Central  Google Scholar 

  32. 32.

    Markman TM, Habibi M, Venkatesh BA et al (2017) Association of left atrial structure and function and incident cardiovascular disease in patients with diabetes mellitus: results from multi-ethnic study of atherosclerosis (MESA). Eur Heart J Cardiovasc Imaging 18(10):1138–1144

    PubMed  PubMed Central  Article  Google Scholar 

  33. 33.

    Kadappu KK, Boyd A, Eshoo S et al (2012) Changes in left atrial volume in diabetes mellitus: more than diastolic dysfunction? Eur Heart J Cardiovasc Imaging 13(12):1016–1023

    PubMed  Article  PubMed Central  Google Scholar 

  34. 34.

    Nemes A, Piros GÁ, Lengyel C et al (2016) Complex evaluation of atrial dysfunction in patients with type 1 diabetes mellitus by three-dimensional speckle tracking echocardiography: results from the MAGYAR-Path Study. Anatol J Cardiol 16(8):587–593

    PubMed  PubMed Central  Google Scholar 

  35. 35.

    Braunauer K, Pieske-Kraigher E, Belyavskiy E et al (2018) Early detection of cardiac alterations by left atrial strain in patients with risk for cardiac abnormalities with preserved left ventricular systolic and diastolic function. Int J Cardiovasc Imaging 34(5):701–711

    PubMed  PubMed Central  Google Scholar 

  36. 36.

    Wang Y, Hou D, Ma R, Ding G, Yin L, Zhang M (2016) Early detection of left atrial energy loss and mechanics abnormalities in diabetic patients with normal left atrial size: a study combining vector flow mapping and tissue tracking echocardiography. Med Sci Monit 22:958–968

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  37. 37.

    Georgievska-Ismail L, Zafirovska P, Hristovski Z (2016) Evaluation of the role of left atrial strain using two-dimensional speckle tracking echocardiography in patients with diabetes mellitus and heart failure with preserved left ventricular ejection fraction. Diab Vasc Dis Res 13(6):384–394

    PubMed  Article  PubMed Central  Google Scholar 

  38. 38.

    Tadic M, Ilic S et al (2015) Left and right atrial phasic function and deformation in untreated patients with prediabetes and type 2 diabetes mellitus. Int J Cardiovasc Imaging 31(1):65–76

    PubMed  Article  PubMed Central  Google Scholar 

  39. 39.

    Tadic M, Vukomanovic V, Cuspidi C, Suzic-Lazic J, Stanisavljevic D, Celic V (2017) Left atrial phasic function and heart rate variability in asymptomatic diabetic patients. Acta Diabetol 54(3):301–308

    PubMed  Article  Google Scholar 

  40. 40.

    Vukomanovic V, Suzic-Lazic J, Celic V et al (2020) Is there association between left atrial function and functional capacity in patients with uncomplicated type 2 diabetes? Int J Cardiovasc Imaging 36(1):15–22

    PubMed  Article  PubMed Central  Google Scholar 

  41. 41.

    Mohseni-Badalabadi R, Mehrabi-Pari S, Hosseinsabet A (2020) Evaluation of the left atrial function by two-dimensional speckle-tracking echocardiography in diabetic patients with obesity. Int J Cardiovasc Imaging 36(4):643–652

    PubMed  Article  PubMed Central  Google Scholar 

  42. 42.

    Hosseinsabet A, Mohseni-Badalabadi R, Moinfar A (2017) Impaired left atrial conduit function in coronary artery disease patients with poorly controlled diabetes: two-dimensional speckle-tracking echocardiographic study. J Ultrasound Med 36(1):13–23

    PubMed  Article  PubMed Central  Google Scholar 

  43. 43.

    Badano LP, Miglioranza MH, Mihăilă S et al (2016) Left atrial volumes and function by three-dimensional echocardiography: reference values, accuracy, reproducibility, and comparison with two-dimensional echocardiographic measurements. Circ Cardiovasc Imaging 9(7):e004229

    PubMed  Article  PubMed Central  Google Scholar 

  44. 44.

    Badano LP, Kolias TJ, Muraru D et al (2018) Industry representatives; Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 19(6):591–600

    PubMed  Article  PubMed Central  Google Scholar 

  45. 45.

    Pathan F, Zainal Abidin HA, Vo QH et al (2019) Left atrial strain: a multi-modality, multi-vendor comparison study. Eur Heart J Cardiovasc Imaging. https://doi.org/10.1093/ehjci/jez303

    Article  Google Scholar 

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Affiliations

  1. University Hospital “Dr. Dragisa Misovic - Dedinje, Department of Cardiology”, Heroja Milana Tepica 1, Belgrade, 11000, Serbia

    Marijana Tadic

  2. University of Milan-Bicocca, Milan, Italy

    Cesare Cuspidi

  3. Clinical Research Unit, Istituto Auxologico Italiano, Viale della Resistenza 23, 20036, Meda, Italy

    Cesare Cuspidi

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  1. Marijana Tadic
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  2. Cesare Cuspidi
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Correspondence to Marijana Tadic.

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Tadic, M., Cuspidi, C. Left atrial function in diabetes: does it help?. Acta Diabetol 58, 131–137 (2021). https://doi.org/10.1007/s00592-020-01557-x

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Keywords

  • Diabetes
  • Left atrium
  • Phasic function
  • Strain