Abstract
Objective: To assess the value of real-time three-dimensional echocardiography (RT-3DE) in evaluating changes in left atrial volume and function in type 2 diabetes mellitus (DM) and type 2 diabetic nephropathy (DN) patients.Method: 104 control subjects, 109 DN patients, and 111 DM patients were recruited and underwent RT-3DE. Data pertaining to the left atrium were analyzed using the 3DQA software in order to determine left atrial maximum volume index (LAVImax), left atrial pre-systolic volume index (LAVIp), left atrial minimum volume index (LAVImin), total left atrial ejection fraction (LAEFt), passive left atrial ejection fraction (LAEFp), and active left atrial ejection fraction (LAEFa). Differences between these three groups and correlations between individual index values and E/e' ratios were additionally assessed.Result: LAVImax, LAVIp, and LAVImin were higher in the DN and DM groups relative to controls, whereas LAEFt and LAEFp were higher in controls relative to DM and DN patients (P < 0.05). LAVImax, LAVIp, and LAVImin in the DN group were significantly higher than those in the DM group, while LAEFt, LAEFp were higher in DM patients relative to DN patients (P < 0.05). The E/e' ratio was also found to be significantly correlated with LAVImax, LAVIp, and LAVImin.Conclusion: Our results indicate that RT-3DE can be used to assess changes in left atrial volume and function in patients with diabetes and can be used to monitor disease progression-related damage to such left atrial functionality.
Highlights
Diabetes mellitus (DM) is a systemic metabolic disease wherein patients suffer from persistently elevated blood glucose levels as a result of impaired insulin production or sensitivity as a result of different environmental and genetic factors
No significant differences were detected among the three groups with respect to systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), heart rate (HR), triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), or low-density lipoprotein cholesterol (LDL-C) levels (P > 0.05) (Table 1)
We observed no significant differences in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular endsystolic diameter (LVESD), left atrial diameter (LAD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), early diastolic peak velocity at the mitral valve orifice (E), late diastolic peak velocity at the mitral valve orifice (A), or late diastolic peak velocity of the mitral annulus (a') among these three participant groups (P > 0.05), whereas we did find that the average E/A value of patients in the diabetic nephropathy (DN) group was significantly lower than that of control group patients
Summary
Diabetes mellitus (DM) is a systemic metabolic disease wherein patients suffer from persistently elevated blood glucose levels as a result of impaired insulin production or sensitivity as a result of different environmental and genetic factors. Left atrial volume and function are key determinants of diastolic left ventricular filling. Some studies have shown that patients with hypertension have increased LA volumes and impaired diastolic functions by using RT-3DE [11, 12]. Compared with 2D ultrasound, RT-3DE does not rely on the geometric shape of each section of the left atrium to obtain its overall shape It can be reliably and used to assess left atrial volume changes during different cardiac cycles with greater sensitivity and accuracy than traditional 2D ultrasound analytical approaches [10, 16]. We sought to assess whether RT-3DE is an effective means of assessing left atrial volume and function in DM patients
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