Left Atrial Volume Index: Relation to Long-Term Clinical Outcome in Type 2 Diabetes

• Published in: Journal of the American College of Cardiology 2013-12, Vol.62 (25), p.2416-2421
• Main Authors: POULSEN, Mikael K, DAHL, Jordi S, HENRIKSEN, Jan Erik, HEY, Thomas M, HØILUND-CARLSEN, Poul Flemming, BECK-NIELSEN, Henning, MØLLER, Jacob E
• Format: Article
• Language: English
• Subjects: Aged; Atrial Function, Left - physiology; Biological and medical sciences; Cardiac Volume - physiology; Cardiology. Vascular system; Diabetes Mellitus, Type 2 - physiopathology; Diabetes Mellitus, Type 2 - therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Single-Blind Method; Time Factors; Treatment Outcome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2013.08.1622

The study sought to determine the prognostic importance of left atrial (LA) dilation in patients with type 2 diabetes mellitus (T2DM) and no history of cardiovascular disease (CVD). T2DM is associated with the development of CVD, and morphological changes in the heart may appear before symptoms arise. A total of 305 T2DM patients without known CVD referred to a diabetes clinic were included consecutively (age 58.6 ± 11.3 years, diabetes duration 2.0 [interquartile range: 0 to 6.0] years). Each patient underwent a comprehensive echocardiogram and a myocardial perfusion scintigraphy (MPS) at inclusion. Patients were divided according to left atrial volume index (LAVi) ≥32 ml/m(2). Patients were followed for median of 5.6 (interquartile range: 5.1 to 6.1) years for the occurrence of major cardiac events and death. LAVi ≥32 ml/m(2) was found in 105 patients (34%). During follow-up, 60 patients (20%) experienced the composite endpoint, of whom 28 (9%) died. Patients with LAVi ≥32 ml/m(2) had a significantly higher cardiac event rate and death rate (p < 0.001 and p = 0.002, respectively). Univariate predictors of the composite endpoint were age, hypertension, left ventricular diastolic function, E/e'septum-ratio and LAVi ≥32 ml/m(2); however, myocardial ischemia on MPS was not a predictor. When adjusting for age and hypertension, only LAVi ≥32 ml/m(2) was a predictor of the composite endpoint (hazard ratio: 1.82 [95% confidence interval: 1.08 to 3.07], p = 0.024). Increased LAVi was an independent and incremental predictor of cardiovascular morbidity and mortality in T2DM patients with no history of CVD. (Presence of Macrovascular Disease in Type 2 Diabetes Mellitus; NCT00298844).