Relationship between increased left atrial volume and microvascular complications in patients with type 2 diabetes

• Published in: Journal of diabetes and its complications 2015-08, Vol.29 (6), p.822-828
• Main Authors: Bonapace, Stefano, Rossi, Andrea, Lipari, Paola, Bertolini, Lorenzo, Zenari, Luciano, Lanzoni, Laura, Canali, Guido, Molon, Giulio, Mantovani, Alessandro, Zoppini, Giacomo, Bonora, Enzo, Barbieri, Enrico, Targher, Giovanni
• Format: Article
• Language: English
• Subjects: Aged; Blood pressure; Cardiac Volume - physiology; Cardiology; Diabetes Mellitus, Type 2 - complications; Diabetic Angiopathies - diagnosis; Diabetic Angiopathies - physiopathology; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - etiology; Diabetic Neuropathies - diagnosis; Diabetic Neuropathies - etiology; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - etiology; Echocardiography; Endocrinology & Metabolism; Female; Heart Atria - diagnostic imaging; Heart Atria - physiopathology; Heart attacks; Hemodynamics; Humans; Left atrial volume; Male; Microvascular complications; Microvessels - physiopathology; Middle Aged; Mortality; Myocardial Perfusion Imaging; Nephropathy; Neuropathy; Retinopathy; Studies; Type 2 diabetes
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2015.05.006

Abstract Aims We assessed whether left atrial volume index (LAVI) was associated with the presence of microvascular complications in patients with type 2 diabetes, and whether this association was independent of hemodynamic and non-hemodynamic factors. Methods We studied 157 consecutive outpatients with type 2 diabetes with no previous history of ischemic heart disease, chronic heart failure and valvular diseases. A transthoracic echocardiography and myocardial perfusion scintigraphy were performed in all participants. Presence of microvascular complications was also recorded. Results Overall, 51 patients had decreased estimated glomerular filtration rate and/or abnormal albuminuria, 24 had diabetic retinopathy, 22 had lower-extremity sensory neuropathy, and 67 (42.7%) patients had one or more of these microvascular complications (i.e., combined endpoint). After stratifying patients by LAVI, those with LAVI ≥ 32 ml/m2 had a greater prevalence of microvascular complication, lower left ventricular (LV) ejection fraction, higher LV mass index and higher E/e’ ratio than those with LAVI < 32 ml/m2 . Logistic regression analyses revealed that microvascular complications (singly or in combination) were associated with increased LAVI, independently of age, sex, diabetes duration, hemoglobin A1c, hypertension, LV-ejection fraction, LV mass index and the E/e’ ratio. Conclusions These results indicate that microvascular diabetic complications are associated with increased LAVI in well-controlled type 2 diabetic patients with preserved systolic function and free from ischemic heart disease, independently of multiple potential confounders.