Early impairment of left atrial systolic function measured by 2D speckle tracking echocardiography in patients with diabetes and hypertension

Arterial hypertension (HT) and diabetes mellitus (DM) are the most common cardiovascular risk factors that precede major cardiovascular events and affect the structural and functional properties of left atrium (LA). The most widely recognized consequence of these entities is the enlargement of LA, whereas the functional changes that occur are less well studied and identified. The aim of this study was to estimate LA function using speckle tracking echocardiography (STE) and LA ejection fraction in patients (pts) with HT, DM or both, with echocardiographic evidence of normal LA size. Methods: LA ejection fraction (LAEF) was calculated by the biplane area-length method from apical 4- and 2-chamber views at end systolic and diastolic phase, while LA strain was studied by STE from the same views, in 101 pts with LA volume indexes < 30 mL/m2 (Group A: 31 pts with HT, Group B: 27 pts with DM, Group C: 23 pts with both DM and HT and Group D: 20 age-matched control pts). The following indexes were measured: peak atrial longitudinal strain (LAPALS), LAEF and fractional shortening of the left ventricle (LVFS). Results: The study population was as follows: Group A: mean age 56±16y, 59% men, Group B: mean age 56±11y, 56% men, Group C: mean age 63±13y, 45% men and Group D: mean age 53±15y, 39% men. LAPALS was lower in pts with HT (24.9±9.0%) and those with DM (22.9±7.8%) than in controls (30.2±7.1%) and further reduced in pts with both DM and HT (19.1±5.3%) (P<0.05), whereas no differences were noted in LA volume, LAEF or LVFS. In multivariate analysis, HT and DM were both independently associated with decrease of LA strain, while LAEF is not impaired in this early stage of the cascade of cardiovascular disease. Conclusions: LA deformation mechanics are impaired in patients with HT or DM with normal LA size. The coexistence of both conditions further impairs LA performance in an additive fashion. LA longitudinal strain appears to be the first modified parameter that can be identified in these patients. Consequently speckle tracking echocardiography may be a valuable tool for the early detection of LA strain abnormalities.