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Left atrial dysfunction in type 2 diabetes mellitus: insights from cardiac MRI

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Abstract

Objectives

The left atrium (LA) modulates left ventricular filling through reservoir, conduit and booster pump functions. Only limited data exist on LA involvement in type 2 diabetes mellitus (DM2). This study sought to assess LA function in asymptomatic DM2 with cardiac MRI. We hypothesized that cardiac MRI can detect LA dysfunction in asymptomatic DM2.

Methods

Forty-five patients with asymptomatic DM2 and 24 normoglycaemic controls were studied. MRI cine imaging was performed to measure LA maximal and minimal volumes. A flow-sensitive phase-contrast gradient-echo sequence was used for flow measurements perpendicular to the orifice of the mitral valve, to quantify active LA stroke volume. LA total, passive and active emptying volumes and fractions were calculated.

Results

LA reservoir function, namely LA total ejection fraction, was significantly greater in controls compared to patients with DM2 (62.2 ± 5.2 vs 57.0 ± 7.6 %, P = 0.004). LA passive ejection fraction was also greater in the controls (26.2 ± 9.5 vs 16.1 ± 11.0 %, P < 0.001). Regarding parameters of LA booster pump function, LA active ejection fraction was not significantly different between groups. DM2 was demonstrated to be an independent determinant of LA function.

Conclusions

Cardiac MRI enables the detection of LA dysfunction in asymptomatic DM2, characterized by a reduction in LA reservoir and conduit functions.

Key Points

• Evaluation of left atrial function is feasible with cardiac MRI

• Type 2 diabetes mellitus is associated with left atrial dysfunction

• Left atrial function modulates left ventricular filling

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Abbreviations

DM2:

type 2 diabetes mellitus

LA:

left atrium

LAEF:

left atrial ejection fraction

LAmax:

left atrial maximal volume

LAmin:

left atrial minimal volume

LApreA:

left atrial volume pre-atrial contraction

LASV:

left atrial stroke volume

LV:

left ventricle

TMF:

transmitral flow

VENC:

velocity encoded

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Acknowledgments

The scientific guarantor of this publication is Filipe Caseiro-Alves. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding under project “DoIT”, co-financed by the European Community Fund FEDER through COMPETE – Programa Operacional Factores de Competitividade. Miguel Patrício kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, case-control study, performed at one institution.

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Authors and Affiliations

  1. Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000–548, Coimbra, Portugal

    Bruno Graça, Maria João Ferreira, Paulo Donato, Leonor Gomes, Miguel Castelo-Branco & Filipe Caseiro-Alves

  2. Medical Imaging Department, Coimbra’s Hospital Centre and University, Coimbra, Portugal

    Bruno Graça, Paulo Donato & Filipe Caseiro-Alves

  3. Cardiology Department, Coimbra’s Hospital Centre and University, Coimbra, Portugal

    Maria João Ferreira

  4. Endocrinology Department, Coimbra’s Hospital Centre and University, Coimbra, Portugal

    Leonor Gomes

Authors
  1. Bruno Graça
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  2. Maria João Ferreira
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  3. Paulo Donato
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  4. Leonor Gomes
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  5. Miguel Castelo-Branco
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  6. Filipe Caseiro-Alves
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Corresponding author

Correspondence to Bruno Graça.

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Graça, B., Ferreira, M.J., Donato, P. et al. Left atrial dysfunction in type 2 diabetes mellitus: insights from cardiac MRI. Eur Radiol 24, 2669–2676 (2014). https://doi.org/10.1007/s00330-014-3299-2

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  • DOI: https://doi.org/10.1007/s00330-014-3299-2

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