Left atrial dysfunction and stiffness in pediatric and adult patients with Type 1 diabetes mellitus assessed with speckle tracking echocardiography.
Type 1 diabetes mellitus
diabetic cardiomyopathy
left atrial function
speckle tracking imaging
Journal
Pediatric diabetes
ISSN: 1399-5448
Titre abrégé: Pediatr Diabetes
Pays: Denmark
ID NLM: 100939345
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
23
05
2020
revised:
05
10
2020
accepted:
15
10
2020
pubmed:
24
10
2020
medline:
11
1
2022
entrez:
23
10
2020
Statut:
ppublish
Résumé
Subclinical diastolic dysfunction in patients with Type 1 diabetes mellitus (T1DM) caused by myocardial injury due to diabetic cardiomyopathy leads to a high risk of death and heart failure. This myocardial injury extends not only to the left ventricle (LV) but also to the left atrium (LA). However, LA function in children and young adults with T1DM has not been extensively studied. Therefore, the aim of this study was to assess LA dysfunction in pediatric and adult patients with T1DM using LA strain analysis with echocardiography. Fifty-three patients (median age: 23 [range: 5-41] years) with T1DM. We divided the patients into three age groups (D1: 5-14 years, D2: 15-24 years, D3: 25-41 years); 53 age- and sex-matched controls were divided into three corresponding groups (C1, C2, and C3). LA and LV functions were evaluated using echocardiography. LA reservoir strain was lower in the D2 and D3 groups than in the C2 and C3 groups (P = 0.001, P = 0.004, respectively). LA conduit strain was lower in the D2 group than in the C2 group (P = 0.002). LA stiffness was significantly greater in the D3 group than in the C3 group (P < 0.001). In patients with T1DM, LA phasic function decreased in adolescents and young adults, and LA stiffness increased in adult patients aged >30 years. LA phasic function and LA stiffness can be potentially used as early markers for diastolic dysfunction.
Sections du résumé
BACKGROUND
Subclinical diastolic dysfunction in patients with Type 1 diabetes mellitus (T1DM) caused by myocardial injury due to diabetic cardiomyopathy leads to a high risk of death and heart failure. This myocardial injury extends not only to the left ventricle (LV) but also to the left atrium (LA). However, LA function in children and young adults with T1DM has not been extensively studied.
OBJECTIVE
Therefore, the aim of this study was to assess LA dysfunction in pediatric and adult patients with T1DM using LA strain analysis with echocardiography.
SUBJECTS
Fifty-three patients (median age: 23 [range: 5-41] years) with T1DM.
METHODS
We divided the patients into three age groups (D1: 5-14 years, D2: 15-24 years, D3: 25-41 years); 53 age- and sex-matched controls were divided into three corresponding groups (C1, C2, and C3). LA and LV functions were evaluated using echocardiography.
RESULTS
LA reservoir strain was lower in the D2 and D3 groups than in the C2 and C3 groups (P = 0.001, P = 0.004, respectively). LA conduit strain was lower in the D2 group than in the C2 group (P = 0.002). LA stiffness was significantly greater in the D3 group than in the C3 group (P < 0.001).
CONCLUSIONS
In patients with T1DM, LA phasic function decreased in adolescents and young adults, and LA stiffness increased in adult patients aged >30 years. LA phasic function and LA stiffness can be potentially used as early markers for diastolic dysfunction.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
303-319Informations de copyright
© 2020 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.
Références
Ryden L, Armstrong PW, Cleland JG, et al. Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus. Results from the ATLAS trial. Eur Heart J. 2000;21:1967-1978.
Shindler DM, Kostis JB, Yusuf S, et al. Diabetes mellitus, a predictor of morbidity and mortality in the studies of left ventricular dysfunction (SOLVD) trials and registry. Am J Cardiol. 1996;77:1017-1020.
Thrainsdottir IS, Aspelund T, Thorgeirsson G, et al. The association between glucose abnormalities and heart failure in the population-based Reykjavik study. Diabetes Care. 2005;28:612-616.
Miki T, Yuda S, Kouzu H, Miura T. Diabetic cardiomyopathy: pathophysiology and clinical features. Heart Fail Rev. 2013;18:149-166.
Schilling JD, Mann DL. Diabetic cardiomyopathy: bench to bedside. Heart Fail Clin. 2012;8:619-631.
From AM, Scott CG, Chen HH, et al. The development of heart failure in patients with diabetes mellitus and pre-clinical diastolic dysfunction a population-based study. J Am Coll Cardiol. 2010;55:300-305.
Sanchis L, Gabrielli L, Andrea R, et al. Left atrial dysfunction relates to symptom onset in patients with heart failure and preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging. 2015;16:62-67.
Rosca M, Popescu BA, Beladan CC, et al. Left atrial dysfunction as a correlate of heart failure symptoms in hypertrophic cardiomyopathy. J Am Soc Echocardiogr. 2010;23:1090-1098.
Welles CC, Ku IA, Kwan DM, Whooley MA, Schiller NB, Turakhia MP. Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the heart and soul study. J Am Coll Cardiol. 2012;59:673-680.
Tan YT, Wenzelburger F, Lee E, et al. Reduced left atrial function on exercise in patients with heart failure and normal ejection fraction. Heart. 2010;96:1017-1023.
Melenovsky V, Borlaug BA, Rosen B, et al. Cardiovascular features of heart failure with preserved ejection fraction versus nonfailing hypertensive left ventricular hypertrophy in the urban Baltimore community: the role of atrial remodeling/dysfunction. J Am Coll Cardiol. 2007;49:198-207.
Gottdiener JS, Kitzman DW, Aurigemma GP, Arnold AM, Manolio TA. Left atrial volume, geometry, and function in systolic and diastolic heart failure of persons > or =65 years of age (the cardiovascular health study). Am J Cardiol. 2006;97:83-89.
Hoit BD. Left atrial size and function: role in prognosis. J Am Coll Cardiol. 2014;63:493-505.
Kim DG, Lee KJ, Lee S, et al. Feasibility of two-dimensional global longitudinal strain and strain rate imaging for the assessment of left atrial function: a study in subjects with a low probability of cardiovascular disease and normal exercise capacity. Echocardiography. 2009;26:1179-1187.
Morris DA, Belyavskiy E, Aravind-Kumar R, et al. Potential usefulness and clinical relevance of adding left atrial strain to left atrial volume index in the detection of left ventricular diastolic dysfunction. JACC Cardiovasc Imaging. 2018;11:1405-1415.
Singh A, Medvedofsky D, Mediratta A, et al. Peak left atrial strain as a single measure for the noninvasive assessment of left ventricular filling pressures. Int J Cardiovasc Imaging. 2018;35:23-32.
Cameli M, Mandoli GE, Loiacono F, Dini FL, Henein M, Mondillo S. Left atrial strain: a new parameter for assessment of left ventricular filling pressure. Heart Fail Rev. 2016;21:65-76.
Kurt M, Wang J, Torre-Amione G, Nagueh SF. Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging. 2009;2:10-15.
Pilichowska-Paszkiet E, Baran J, Sygitowicz G, et al. Noninvasive assessment of left atrial fibrosis. Correlation between echo cardiography, biomarkers, and electroanatomical mapping. Echocardiography. 2018;35:1326-1334.
Acar G, Akcay A, Sokmen A, et al. Assessment of atrial electromechanical delay, diastolic functions, and left atrial mechanical functions in patients with type 1 diabetes mellitus. J Am Soc Echocardiogr. 2009;22:732-738.
Rakha S, Aboelenin HM. Left ventricular functions in pediatric patients with ten years or more type 1 diabetes mellitus: conventional echocardiography, tissue Doppler, and two-dimensional speckle tracking study. Pediatr Diabetes. 2019;20:946-954.
Nagueh SF, Smiseth OA, Appleton CP, et al. 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. 2016;17:1321-1360.
Peters DC, Duncan JS, Grunseich K, et al. Lower left atrial strain in the presence of regional atrial fibrosis: an MRI study of patients with atrial fibrillation. J Cardiovasc Magn Reson. 2016;18:1-2.
Kuppahally SS, Akoum N, Burgon NS, et al. Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging. 2010;3:231-239.
Harada M, van Wagoner DR, Nattel S. Role of inflammation in atrial fibrillation pathophysiology and management. Circ J. 2014;79:495-502.
Bugger H, Abel ED. Molecular mechanisms of diabetic cardiomyopathy. Diabetologia. 2014;57:660-671.
Westermeier F, Riquelme JA, Pavez M, et al. New molecular insights of insulin in diabetic cardiomyopathy. Front Physiol. 2016;7:125.
Murarka S, Movahed MR. Diabetic cardiomyopathy. J Card Fail. 2010;16:971-979.
Vasquez N, Ostrander BT, Lu DY, et al. Low left atrial strain is associated with adverse outcomes in hypertrophic cardiomyopathy patients. J Am Soc Echocardiogr. 2019;32:593-603.
Rosca M, Lancellotti P, Popescu BA, Pierard LA. Left atrial function: pathophysiology, echocardiographic assessment, and clinical applications. Heart. 2011;97:1982-1989.
Vieira MJ, Teixeira R, Goncalves L, Gersh BJ. Left atrial mechanics: echocardiographic assessment and clinical implications. J Am Soc Echocardiogr. 2014;27:463-478.
Toma Y, Matsuda Y, Moritani K, et al. Left atrial filling in normal human subjects: relation between left atrial contraction and left atrial early filling. Cardiovasc Res. 1987;21:255-259.
Manning WJ, Silverman DI, Katz SE, Douglas PS. Atrial ejection force: a noninvasive assessment of atrial systolic function. J Am Coll Cardiol. 1993;22:221-225.
Huynh QL, Kalam K, Iannaccone A, Negishi K, Thomas L, Marwick TH. Functional and anatomic responses of the left atrium to change in estimated left ventricular filling pressure. J Am Soc Echocardiogr. 2015;28:1428-1433.
Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP. Left atrial structure and function, and left ventricular diastolic dysfunction: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73:1961-1977.
Brecht A, Oertelt-Prigione S, Seeland U, et al. Left atrial function in preclinical diastolic dysfunction: two-dimensional speckle-tracking echocardiography-derived results from the BEFRI trial. J Am Soc Echocardiogr. 2016;29:750-758.
Singh A, Addetia K, Maffessanti F, Mor-Avi V, Lang RM. LA strain for categorization of LV diastolic dysfunction. JACC Cardiovasc Imaging. 2017;10:735-743.
Barbier P, Solomon SB, Schiller NB, Glantz SA. Left atrial relaxation and left ventricular systolic function determine left atrial reservoir function. Circulation. 1999;100:427-436.
Tabata T, Oki T, Yamada H, et al. Role of left atrial appendage in left atrial reservoir function as evaluated by left atrial appendage clamping during cardiac surgery. Am J Cardiol. 1998;81:327-332.
Masaki M, Komamura K, Goda A, et al. Long-term effects of irbesartan on plasma aldosterone concentration and left atrial volume in hypertensive patients. J Cardiol. 2014;63:205-210.
Rawshani A, Sattar N, Franzén S, et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet. 2018;392:477-486.
Iso T, Takahashi K, Yazaki K, et al. In-depth insight into the mechanisms of cardiac dysfunction in patients with type 1 diabetes mellitus using layer-specific strain analysis. Circ J. 2019;83:1330-1337.
Peterson LR, Waggoner AD, Fuentes LD. Alterations in left ventricular structure and function in type-1 diabetics: a focus on left atrial contribution to function. J Am Soc Echocardiogr. 2006;19:749-755.
Grandi AM, Piantanida E, Franzetti I, et al. Effect of glycemic control on left ventricular diastolic function in type 1 diabetes mellitus. Am J Cardiol. 2006;97:71-76.