Impaired Mechanics of Left Ventriculo-Atrial Coupling in Patients With Diabetic Nephropathy

Background:Diabetic nephropathy is independently associated with longitudinal systolic dysfunction of the left ventricle (LV) in asymptomatic diabetes mellitus (DM) patients with preserved LV ejection fraction (LVEF). However, the effect of diabetic nephropathy on left atrial (LA) function remains u...

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Published in:Circulation Journal 2016/08/25, Vol.80(9), pp.1957-1964
Main Authors: Mochizuki, Yasuhide, Tanaka, Hidekazu, Matsumoto, Kensuke, Sano, Hiroyuki, Shimoura, Hiroyuki, Ooka, Junichi, Sawa, Takuma, Ryo-Koriyama, Keiko, Hirota, Yushi, Ogawa, Wataru, Hirata, Ken-ichi
Format: Article
Language:English
Subjects:
Adult
Aged
Atrium
Diabetes mellitus
Diabetic Nephropathies - diagnostic imaging
Diabetic Nephropathies - physiopathology
Echocardiography
Heart Atria - diagnostic imaging
Heart Atria - physiopathology
Heart Ventricles - diagnostic imaging
Heart Ventricles - physiopathology
Humans
Middle Aged
Myocardial contraction
Speckle tracking
Stroke Volume
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Summary:Background:Diabetic nephropathy is independently associated with longitudinal systolic dysfunction of the left ventricle (LV) in asymptomatic diabetes mellitus (DM) patients with preserved LV ejection fraction (LVEF). However, the effect of diabetic nephropathy on left atrial (LA) function remains unknown.Methods and Results:We studied 198 asymptomatic DM patients (LVEF ≥50%). Diabetic nephropathy was defined as a protein level higher than for micro-albuminuria. LV global longitudinal strain (GLS) and LA strain were analyzed by 2D speckle-tracking; 69 age-, sex-, and LVEF-matched controls were also studied. GLS and LA strain in systole (LAS-s) decreased significantly from normal controls to DM patients without (n=137) and with nephropathy (n=61), in that order. Furthermore, GLS, LAS-s, and LA strain in late diastole (LAS-a) were significantly lower in DM patients with macro-albuminuria (n=19) than in those with micro-albuminuria (n=42). Although 1 multivariate regression analysis identified albuminuria as an independent determinative factor of LAS-s among other relevant clinical background factors (β=−0.16, P=0.002), another multivariate regression model for LAS-s+GLS (β=0.40, P
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.CJ-16-0488