Author + information
- Turyan Abdulhalikov,
- Enes Elvin Gül,
- Hakan Akilli,
- Mehmet Kayrak,
- Hajrudin Alibaşiç,
- Mehmet Yazici and
- Hasan Gök
It is well known that diabetes leads to impairment of atrial fuctions. Nevertheless, impaired atrial function is an independent predictor of atrial fibrillation. Although there are several studies demonstrating impaired atrial functions in diabetic patients, data regarding pre-diabetic (Pre-DM) patients are scarce. The aim of this study was to evaluate atrial functions including mechanical and tissue doppler parameters in pre-diabetic patients.
We enrolled 80 patients diagnosed with pre-diabetes and 40 controls with normal glucose levels. Pre-diabetes was diagnosed according to American Diabetes Association (ADA-2013) guidelines. According to the ADA guidelines 27 of our patients were isolated in the impaired fasting glucose group (i-IFG) pre-dm and 53 were in the combined group (fasting plasma glucose levels of 100 mg/dl to 125 mg/dl and oral glucose tolerance test values of 140 mg/dl to 199 mg/dl) pre-dm (Totally 80 pre-dm patients). Atrial tissue doppler parameters were measured with transthoracic echocardiography. Both left and right atrial measurements were performed at peak regional atrial contraction velocity (Va), which reflects atrial systolic functions, atrial mechanical times (The time between the onset of P wave on the surface ECG to the onset to peak Tp, the end of the atrial contraction (Te), and atrial mechanical functions (derived from atrial volumes, which are indexed to body surface area) were compared between groups (figures 1, 2).
The main demographic characteristics were comparable between groups. There was no significant difference between control and i-IFG group pre-dm in all atrial parameters. Also there was no significant difference between groups in terms of Va (Table). But To and Te values were significantly higher in pre-dm patients compared with control group (Table). These differences were clearly seen between the control group and the combined group pre-dm subjects. Of the atrial mechanical functions, passive empting fraction and diastolic emptying fraction were significantly decreased in pre-dm patients (especially in combined group pre-dm) compared with controls (19.2±7.9 vs. 25.9±7.5 mL/m2, p<0.001 and 43.6±13.8 vs 34.4±5.9 ml/m2, p=0.001, respectively) (Table).
Atrial functions are impaired in the pre-diabetic period before development of overt diabetes. This condition is an evidence of that chronic hyperglycemia may contribute to atrial re-modeling with numerous mechanisms before development of diabetes mellitus.
|Variables||Control (n=40)||Pre-DM (n=80)||P values|
|LA Va(cm/s)||8.97±2.1||9.62± 2.0||0.11|
|RA Va (cm/s)||11.07±2.2||11.28±2.2||0.64|
|IAS To (ms)||28.5±7.3||34.2±10.7||0.003|
|IAS Tp (ms)||82.95±15.2||86.78±20.9||0.26|
|IAS Te (ms)||123.1±13.3||134.7±23.7||0.001|
|LA To (ms)||29.58±8.8||36.11±10.23||0.001|
|LA Tp (ms)||88.85±16.5||96.75±24.4||0.07|
|LA Te (ms)||124.85±16.2||139.81±24.6||p<0.001|
|RA To (ms)||28.40±7.6||32.68±9.8||0.01|
|RA Tp (ms)||88.03±14.6||92.96±26.2||0.20|
|RA Te (ms)||130.50±14.0||145.4±29.4||p<0.001|
|Passive emptying fraction(%)||19.2±7.9||25.9±7.5||p<0.001|
|Diastolic emptying fraction(%)||43.6±13||34.4±5.9||0.001|
|Active emptying fraction (%)||22.8±7.6||27.2±13.7||0.09|
Comparison of atrial functions. Pre-DM,prediabetes; IAS,inter-atrial septum; LA-left atrium; RA-right atrium; Va-regional atrial contraction peak velocity; The time between the onset of P wave on the surface ECG to the onset To, to peak Tp, and end of the atrial contraction Te.