Author + information
- Naile Eris Güdül,
- Turgut Karabağ,
- Muhammet Rasit Sayin,
- Ibrahim Akpinar,
- Nesimi Yavuz and
- Mustafa Aydin
Prediabetes is a predictor of manifest diabetes mellitus (DM) and is known to be associated with increased cardiovascular mortality and morbidity. As the diabetic patients are at higher risk of developing atrial fibrillation (AF), a significant part of the patients with lone AF are also diabetic. Inter-atrial and intra-atrial electromechanical coupling time which can be measured by both prolonged P wave dispersion and tissue Doppler imaging are known as the non-invasive predictors of atrial fibrillation. Impairment of left mechanical functions could be associated with the increased risk of developing AF. In our study, we examined the atrial electromechanical coupling time which is measured by the tissue Doppler imaging (TDI), left atrial (LA) mechanical function by disc method, and P wave dispersion of the prediabetic patients.
50 prediabetic (22 M, 28 F; median age: 51±10 years) and 41 healthy subjects as control group included in this study. Atrial electromechanical coupling time was calculated from lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid) by TDI. Left atrial volumes (maximum, minimum, and pre-systolic) were measured in the apical four-chamber view with the disk method and were indexed to body surface area. Left atrial mechanical functions (LAPEV, LAPEF, LAAEV, LAAEF, CV, LATEV) were evaluated. P wave dispersion was obtained by 12-lead electrocardiography and was calculated as subtracting the minimum P wave duration from maximum P wave duration period. The results of prediabetic and control groups were analysed.
Inter-atrial (PA lateral-PA tricuspid) and left atrial electromechanical delays were found to be significantly longer in patients with prediabetes than the control group (21.5±10.5 vs 13.8±5.6 msec; p < 0.001, 12.5±8.1 vs 6.7±3.7, p < 0.001, respectively). Maximum and pre-systolic volumes were found to be similar in both groups (29.1±7.2 to 27.1±8.2, p=0.24, 18.6±4.4 to 17.8±6.6, p=0.14, respectively). In the prediabetic patients, LATEV, LAAEV, CV and LAAEF were found to be higher than the control group (18,8±6,3 vs 16,1±4,5, p=0,01; 8,7±3,1 to 5,7±2,4; p<0,001, 31,3±8,3 vs 27,5±9,7, p=0,047; 0,53±0,16 vs 0,31±0,13, p<0,001, respectively).
In prediabetic patients, P-wave dispersion was found to be longer than the control group (55,3±11,1 msec to 28.9±5.9 msec, p<0.001, respectively).
Prolonged atrial electromechanical delay and prolonged PWD suggested that prediabetic population have an increased risk for development of AF than the normal population. Impaired left atrial mechanical functions could be a predictor of the heart failure and atrial fibrillation which may develop in future. In our opinion, in patients with presiabetes, some precautions are to be taken before the development of overt diabetes, may prevent such cardiovascular complications as AF and heart failure.