Assessment of Echocardiography-Derived Total Atrial Activation Time at Patients with Type 2 Diabetes Mellitus

Abstract

Objectives: Atrial fibrillation (AF) is one of the main cardiovascular complications associated with type 2 diabetes mellitus (T2DM). Echocardiography-derived total atrial activation time (PA-TDI duration) which reflects electrical and structural changes to the atria, consistently and accurately predicts new-onset AF. In this study, we aimed to determine the value of PA-TDI duration in T2DM patients. Methods: A total of 40 consecutive patients with T2DM, mean age 51.5 ± 14.3 years, and 40 age and gender-matched healthy volunteers were evaluated. Conventional and tissue Doppler echocardiography were performed. Additionally, we determined the PA-TDI duration as the time interval from the onset of the P-wave in lead II of the ECG to the peak A’-wave on the tissue Doppler tracing. Results: Left atrial (LA) diameter and LA volume index were significantly higher in T2DM patients (3.36 ± 0.5 cm vs.3.10 ± 0.45cm, p=0.037; 30.8 ± 30ml/m2 vs. 29.0 ± 3.4ml/m2, p=0.03 respectively). Mitral A velocity was significantly higher in T2DM patients (69.72 ± 10.16 cm/s vs. 64.75 ± 10.64 cm/s, p=0.029). Doppler E/A ratio was lower in T2DM patients. Tissue Doppler E’/A’ ratio for left ventricular lateral annulus was significantly lower in the diabetic group (1.28±0.33 vs. 1.49±0.40, p=0.024) and E/E’ was significantly higher in the diabetic group (7.33±2.5 vs. 6.45±1.1, p=0.038). PA-TDI duration was significantly higher in the T2DM patients when compared with the controls (134.2±6.0ms vs. 124.3±9.4ms p<0.001). Conclusions: Our results showed that PA-TDI duration is significantly increased in patients with T2DM as compared with healthy volunteers. PA-TDI duration measurement, using transthoracic echocardiography can serve as an easy and non-invasive method of detecting patients with T2DM at risk of atrial fibrillation.