Assessment of left atrioventricular coupling and left atrial function impairment in diabetes with and without hypertension using CMR feature tracking

Rui Shi; Yi-Ning Jiang; Wen-Lei Qian; Ying-Kun Guo; Yue Gao; Li-Ting Shen; Li Jiang; Xue-Ming Li; Zhi-Gang Yang; Yuan Li

doi:10.1186/s12933-023-01997-z

Assessment of left atrioventricular coupling and left atrial function impairment in diabetes with and without hypertension using CMR feature tracking

Cardiovasc Diabetol. 2023 Oct 30;22(1):295. doi: 10.1186/s12933-023-01997-z.

Authors

Rui Shi¹, Yi-Ning Jiang¹, Wen-Lei Qian¹, Ying-Kun Guo², Yue Gao¹, Li-Ting Shen¹, Li Jiang¹, Xue-Ming Li¹, Zhi-Gang Yang^#³, Yuan Li^#⁴

Affiliations

¹ Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
² Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
³ Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China. yangzg666@163.com.
⁴ Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China. dr.liyuan@163.com.

^# Contributed equally.

Abstract

Purpose: The study was designed to assess the effect of co-occurrence of diabetes mellitus (DM) and hypertension on the deterioration of left atrioventricular coupling index (LACI) and left atrial (LA) function in comparison to individuals suffering from DM only.

Methods: From December 2015 to June 2022, we consecutively recruited patients with clinically diagnosed DM who underwent cardiac magnetic resonance (CMR) at our hospital. The study comprised a total of 176 patients with DM, who were divided into two groups based on their blood pressure status: 103 with hypertension (DM + HP) and 73 without hypertension (DM-HP). LA reservoir function (reservoir strain (ε_s), total LA ejection fraction (LAEF)), conduit function (conduit strain (ε_e), passive LAEF), booster-pump function (booster strain (ε_a) and active LAEF), LA volume index (LAVI), LV global longitudinal strain (LVGLS), and LACI were evaluated and compared between the two groups.

Results: After adjusting for age, sex, body surface area (BSA), and history of current smoking, total LAEF (61.16 ± 14.04 vs. 56.05 ± 12.72, p = 0.013) and active LAEF (43.98 ± 14.33 vs. 38.72 ± 13.51, p = 0.017) were lower, while passive LAEF (33.22 ± 14.11 vs. 31.28 ± 15.01, p = 0.807) remained unchanged in the DM + HP group compared to the DM-HP group. The DM + HP group had decreased ε_s (41.27 ± 18.89 vs. 33.41 ± 13.94, p = 0.006), ε_e (23.69 ± 12.96 vs. 18.90 ± 9.90, p = 0.037), ε_a (17.83 ± 8.09 vs. 14.93 ± 6.63, p = 0.019), and increased LACI (17.40±10.28 vs. 22.72±15.01, p = 0.049) when compared to the DM-HP group. In patients with DM, multivariate analysis revealed significant independent associations between LV GLS and εs (β=-1.286, p < 0.001), εe (β=-0.919, p < 0.001), and εa (β=-0.324, p = 0.036). However, there was no significant association observed between LV GLS and LACI (β=-0.003, p = 0.075). Additionally, hypertension was found to independently contribute to decreased εa (β=-2.508, p = 0.027) and increased LACI in individuals with DM (β = 0.05, p = 0.011).

Conclusions: In DM patients, LV GLS showed a significant association with LA phasic strain. Hypertension was found to exacerbate the decline in LA booster strain and increase LACI in DM patients, indicating potential atrioventricular coupling index alterations.

Keywords: Cardiac MRI; Cardiomyopathy; Diabetes mellitus; Hypertension; Left atrial dysfunction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Atrial Function, Left
Diabetes Mellitus* / diagnosis
Diabetes Mellitus* / epidemiology
Diabetes Mellitus* / pathology
Heart Atria / diagnostic imaging
Humans
Hypertension* / complications
Hypertension* / diagnosis
Hypertension* / epidemiology
Magnetic Resonance Spectroscopy