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Evaluation of the left atrial function by two-dimensional speckle-tracking echocardiography in diabetic patients with obesity

  • Reza Mohseni-Badalabadi
  • Samira Mehrabi-Pari
  • Ali HosseinsabetEmail author
Original Paper
  • 13 Downloads

Abstract

Obesity and diabetes are risk factors for atrial cardiomyopathy and are, thus, deemed public health concerns. However, the effects of obesity on the left atrial (LA) function in patients with diabetes have not been determined yet. We sought to evaluate the effects of obesity on the LA function in patients with type 2 diabetes. Ninety-six consecutive patients with type 2 diabetes without significant coronary artery stenosis in selective coronary angiography were included in this cross-sectional study. Two-dimensional speckle-tracking echocardiography (2DSTE)-derived longitudinal LA myocardial deformation markers were compared between 42 obese and 54 nonobese patients. The longitudinal strain and the longitudinal strain rate of the LA myocardium during the reservoir phase and the contraction phase were reduced in the obese patients with diabetes compared with the nonobese patients with diabetes in the unadjusted analysis. In the adjusted analysis, longitudinal strain and the longitudinal strain rate during the contraction phase and the longitudinal strain rate during the reservoir phase were decreased in the obese patients with diabetes. The reservoir and contraction functions of the LA as evaluated by 2DSTE were decreased in our obese patients with diabetes compared with our nonobese patients with diabetes.

Keywords

Left atrium Obesity Diabetes Two-dimensional speckle-tracking echocardiography 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all the patients participating in the study.

Ethical approval

All the procedures performed in this study involving human patients were in accordance with the ethical standards of our university and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Bhupathiraju SN, Hu FB (2016) Epidemiology of obesity and diabetes and their cardiovascular complications. Circ Res 118:1723–1735PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Hales CM, Carroll MD, Fryar CD, Ogden CL (2017) Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief 288:1–8Google Scholar
  3. 3.
    Colosia AD, Palencia R, Khan S (2013) Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review. Diabetes Metab Syndr Obes 6:327–338PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Wilding JP (2014) The importance of weight management in type 2 diabetes mellitus. Int J Clin Pract 68:682–691PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Kwon Y, Kim HJ, Park S, Park YG, Cho KH (2017) Body mass index-related mortality in patients with type 2 diabetes and heterogeneity in obesity paradox studies: a dose-response meta-analysis. PLoS ONE ONE 12:e0168247CrossRefGoogle Scholar
  6. 6.
    Mandviwala T, Khalid U, Deswal A (2016) Obesity and cardiovascular disease: a risk factor or a risk marker? Curr Atheroscler Rep 18:21PubMedCrossRefGoogle Scholar
  7. 7.
    Lehrke M, Marx N (2017) Diabetes mellitus and heart failure. Am J Cardiol 120:S37–S47PubMedCrossRefGoogle Scholar
  8. 8.
    Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH (2017) Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ Res 120:1501–1517PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Kebed KY, Addetia K, Lang RM (2019) Importance of the left atrium: more than a bystander? Heart Fail Clin 15:191–204PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Hoit BD (2018) Assessment of left atrial function by echocardiography: novel insights. Curr Cardiol Rep 20:96PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Singla R, Murthy M, Singla S, Gupta Y (2019) Friendly fat theory - explaining the paradox of diabetes and obesity. Eur Endocrinol 15:25–28PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Abi Khalil C, Sulaiman K, Singh R, Jayyousi A, Asaad N, AlHabib KF, Alsheikh-Ali A, Al-Jarallah M, Bulbanat B, AlMahmeed W, Dargham S, Ridha M, Bazargani N, Amin H, Al-Motarreb A, AlFaleh H, Elasfar A, Panduranga P, Al Suwaidi J (2017) BMI is inversely correlated to the risk of mortality in patients with type 2 diabetes hospitalized for acute heart failure: findings from the Gulf aCute heArt failuRE (Gulf-CARE) registry. Int J Cardiol 241:262–269PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Won KB, Hur SH, Cho YK, Yoon HJ, Nam CW, Kim KB, Bae JH, Choi DJ, Ahn YK, Park JS, Kim HS, Choi RK, Choi D, Kim JH, Han KR, Park HS, Choi SY, Yoon JH, Kwon HC, Rha SU, Hwang KK, Lim DS, Jung KT, Oh SK, Lee JH, Shin ES, Kim KS (2015) Comparison of 2-year mortality according to obesity in stabilized patients with type 2 diabetes mellitus after acute myocardial infarction: results from the DIAMOND prospective cohort registry. Cardiovasc Diabetol 14:141PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Patel H, Bhutani S, Posimreddy S, Shah P, Rampal U, Gandhi A, Vasudev R, Pullatt R, Virk H, Shamoon F, Bikkina M, Goldfarb I (2018) The obesity paradox: the protective effect of obesity on right ventricular function using echocardiographic strain imaging in patients with pulmonary hypertension. Minerva Cardioangiol 66:523–527PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Alhamshari YS, Alnabelsi T, Mulki R, Cepeda-Valery B, Figueredo VM, Romero-Corral A (2017) Right ventricular function measured by TAPSE in obese subjects at the time of acute myocardial infarction and 2 year outcomes. Int J Cardiol 232:181–185PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Badano LP, Kolias TJ, Muraru D, Abraham TP, Aurigemma G, Edvardsen T, D'Hooge J, Donal E, Fraser AG, Marwick T, Mertens L, Popescu BA, Sengupta PP, Lancellotti P, Thomas JD, Voigt JU, Industry representatives; Reviewers: This document was reviewed by members of the 2016–2018 EACVI Scientific Documents Committee (2018) Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 19:591–600PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Tadic M, Ilic S, Cuspidi C, Ivanovic B, Bukarica L, Kostic N, Marjanovic T, Kocijancic V, Celic V (2015) Left and right atrial phasic function and deformation in untreated patients with prediabetes and type 2 diabetes mellitus. Int J Cardiovasc Imaging 31:65–76PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Tadic M, Cuspidi C, Ilic I, Suzic-Lazić J, Zivanovic V, Jozika L, Celic V (2016) The relationship between blood pressure variability, obesity and left atrial phasic function in hypertensive population. Int J Cardiovasc Imaging 32:603–612PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Gulel O, Yuksel S, Soylu K, Kaplan O, Yilmaz O, Kahraman H, Sahin M (2009) Evaluation of left atrial functions by color tissue Doppler imaging in adults with body mass indexes %3e or = 30 kg/m(2) versus those %3c30 kg/m (2). Int J Cardiovasc Imaging 25:371–377PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, Oki T (2014) Contribution of obesity to left atrial and left ventricular dysfunction in asymptomatic patients with hypertension: a two-dimensional speckle-tracking echocardiographic study. J Am Soc Hypertens 8:54–63PubMedCrossRefGoogle Scholar
  21. 21.
    Chirinos JA, Sardana M, Satija V, Gillebert TC, De Buyzere ML, Chahwala J, De Bacquer D, Segers P, Rietzschel ER, Asklepios Investigators (2019) Effect of obesity on left atrial strain in persons aged 35–55 years (The Asklepios Study). Am J Cardiol 123:854–861PubMedCrossRefGoogle Scholar
  22. 22.
    Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GY, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S (2017) EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Heart Rhythm 14:e3–e40PubMedCrossRefGoogle Scholar
  23. 23.
    Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    American Diabetes Association (2018) Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care 41:S13–S27CrossRefGoogle Scholar
  25. 25.
    Chung F, Abdullah HR, Liao P (2016) STOP-Bang Questionnaire: a practical approach to screen for obstructive sleep apnea. Chest 149:631–638PubMedCrossRefGoogle Scholar
  26. 26.
    Chiu HY, Chen PY, Chuang LP, Chen NH, Tu YK, Hsieh YJ, Wang YC, Guilleminault C (2017) Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev 36:57–70PubMedCrossRefGoogle Scholar
  27. 27.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39.e14PubMedCrossRefGoogle Scholar
  28. 28.
    Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107–133PubMedCrossRefGoogle Scholar
  29. 29.
    Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD (2016) 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. J Am Soc Echocardiogr 29:277–314PubMedCrossRefGoogle Scholar
  30. 30.
    Ramkumar S, Yang H, Wang Y, Nolan M, Negishi T, Negishi K, Marwick TH (2017) Association of the active and passive components of left atrial deformation with left ventricular function. J Am Soc Echocardiogr 30:659–666PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Kim SM, Cho KI, Kwon JH, Lee HG, Kim TI (2012) Impact of obstructive sleep apnea on left atrial functional and structural remodeling beyond obesity. J Cardiol 60:475–483PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Altekin RE, Yanikoglu A, Karakas MS, Ozel D, Kucuk M, Yilmaz H, Demir I (2012) Assessment of left atrial dysfunction in obstructive sleep apnea patients with the two dimensional speckle-tracking echocardiography. Clin Res Cardiol 101:403–413PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G (2013) Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol 62:569–576PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Homan EA, Reyes MV, Hickey KT, Morrow JP (2019) Clinical overview of obesity and diabetes mellitus as risk factors for atrial fibrillation and sudden cardiac death. Front Physiol 9:1847PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Alpert MA, Omran J, Mehra A, Ardhanari S (2014) Impact of obesity and weight loss on cardiac performance and morphology in adults. Prog Cardiovasc Dis 56:391–400PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Goudis CA, Korantzopoulos P, Ntalas IV, Kallergis KDG (2015) Obesity and atrial fibrillation: a comprehensive review of the pathophysiological mechanisms and links. J Cardiol 66:361–369PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Csige I, Ujvárosy D, Szabó Z, Lőrincz I, Paragh G, Harangi M, Somodi S (2018) The impact of obesity on the cardiovascular system. J Diabetes Res 2018:3407306PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Liao JN, Chao TF, Kuo JY, Sung KT, Tsai JP, Lo CI, Lai YH, Su CH, Hung CL, Yeh HI, Chen SA (2017) Age, sex, and blood pressure-related influences on reference values of left atrial deformation and mechanics from a large-scale Asian population. Circ Cardiovasc Imaging 10:e006077PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Sugimoto T, Robinet S, Dulgheru R, Bernard A, Ilardi F, Contu L, Addetia K, Caballero L, Kacharava G, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Hagendorff A, Hristova K, Lopez T, de la Morena G, Popescu BA, Penicka M, Ozyigit T, Rodrigo Carbonero JD, van de Veire N, Von Bardeleben RS, Vinereanu D, Zamorano JL, Go YY, Marchetta S, Nchimi A, Rosca M, Calin A, Moonen M, Cimino S, Magne J, Cosyns B, Galli E, Donal E, Habib G, Esposito R, Galderisi M, Badano LP, Lang RM, Lancellotti P, NORRE Study (2018) Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 19:630–638PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G (2019) Left atrial function in elite athletes: a meta-analysis of two-dimensional speckle tracking echocardiographic studies. Clin Cardiol 42:579–587PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Konerman MC, Greenberg JC, Kolias TJ, Corbett JR, Shah RV, Murthy VL, Hummel SL (2018) Reduced myocardial flow reserve is associated with diastolic dysfunction and decreased left atrial strain in patients with normal ejection fraction and epicardial perfusion. J Card Fail 24:90–100PubMedCrossRefGoogle Scholar
  42. 42.
    Kuzeytemiz M, Tenekecioglu E, Yilmaz M, Senturk M, Demir S, Bekler A, Aslan B (2015) Assessment of left atrial functions in cardiac syndrome X. Eur Rev Med Pharmacol Sci 19:3023–3029PubMedGoogle Scholar
  43. 43.
    Acıkgoz N, Yagmur J, Kurtoglu E, Ermis N, Cansel M (2017) Left atrial volume and function in patients with cardiac syndrome X assessed by real time three-dimensional echocardiography. Echocardiography 34:862–868PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2020

Authors and Affiliations

  1. 1.Cardiology Department, Tehran Heart CenterTehran University of Medical SciencesTehranIslamic Republic of Iran

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