Prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitus
BackgroundAlthough the left atrium (LA) plays a key role in the pathophysiology and disease progression of heart failure with preserved ejection fraction (HFpEF), the impact of type 2 diabetes mellitus (T2DM) on LA function and stiffness in HFpEF patients remains unclear. Furthermore, the prognostic...
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.947639/full |
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| author | Shuangshuang Zhu Shuangshuang Zhu Shuangshuang Zhu Yixia Lin Yixia Lin Yixia Lin Yanting Zhang Yanting Zhang Yanting Zhang Guohua Wang Mingzhu Qian Mingzhu Qian Mingzhu Qian Lang Gao Lang Gao Lang Gao Mengmeng Ji Mengmeng Ji Mengmeng Ji Mingxing Xie Mingxing Xie Mingxing Xie Yuman Li Yuman Li Yuman Li Li Zhang Li Zhang Li Zhang |
| author_facet | Shuangshuang Zhu Shuangshuang Zhu Shuangshuang Zhu Yixia Lin Yixia Lin Yixia Lin Yanting Zhang Yanting Zhang Yanting Zhang Guohua Wang Mingzhu Qian Mingzhu Qian Mingzhu Qian Lang Gao Lang Gao Lang Gao Mengmeng Ji Mengmeng Ji Mengmeng Ji Mingxing Xie Mingxing Xie Mingxing Xie Yuman Li Yuman Li Yuman Li Li Zhang Li Zhang Li Zhang |
| author_sort | Shuangshuang Zhu |
| collection | DOAJ |
| description | BackgroundAlthough the left atrium (LA) plays a key role in the pathophysiology and disease progression of heart failure with preserved ejection fraction (HFpEF), the impact of type 2 diabetes mellitus (T2DM) on LA function and stiffness in HFpEF patients remains unclear. Furthermore, the prognostic value of different phases of LA function and stiffness is less well-established in HFpEF patients.MethodsThis study prospectively enrolled 164 HFpEF patients who were in sinus rhythm at the time of echocardiography, including 61 (37%) HFpEF patients with T2DM. LA reservoir, conduit, and pump function were assessed using two-dimensional volume indices and speckle tracking echocardiography. The LA stiffness was calculated as the ratio of early mitral inflow velocity-to-early annular tissue velocity (E/e’) and LA reservoir function. The primary end point was a combined outcome of heart failure hospitalization or death.ResultsLeft atrium reservoir function [measured by peak LA strain (LAS-peak)] and LA pump function (measured by LAS-active) remained significantly lower in the HFpEF patients with T2DM compared with those without T2DM, even after adjustment for potential confounders. In addition, the LA stiffness of HFpEF patients with T2DM was higher than those without T2DM. After a median follow-up of 13.7 months, 46 patients (28.1%) reached the composite end point. LAS-peak (hazard ratios: 0.88; 95% confidence interval: 0.81–0.95; P = 0.001) was significantly associated with the risk of heart failure hospitalization or death after adjusting for demographic and clinical characteristics, LV global longitudinal strain, E/e’, and LA volume index. In contrast, other LA function and stiffness parameters did not independently predict the risk of adverse events. Kaplan-Meier analysis showed that HFpEF patients with T2DM and low LAS-peak (<27.2%) had a significantly increased risk of heart failure-related hospitalization or death (log-rank P < 0.001).ConclusionLeft atrium reservoir and pump function are impaired, whereas LA stiffness is increased in HFpEF patients with T2DM compared with those without T2DM. LAS-peak is a powerful predictor of adverse clinical outcomes and may be crucial for risk stratification in HFpEF patients with and without T2DM. |
| first_indexed | 2024-04-11T20:28:00Z |
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| language | English |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-47549bc0f9684c02a9837f9b864f64022022-12-22T04:04:36ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-09-01910.3389/fcvm.2022.947639947639Prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitusShuangshuang Zhu0Shuangshuang Zhu1Shuangshuang Zhu2Yixia Lin3Yixia Lin4Yixia Lin5Yanting Zhang6Yanting Zhang7Yanting Zhang8Guohua Wang9Mingzhu Qian10Mingzhu Qian11Mingzhu Qian12Lang Gao13Lang Gao14Lang Gao15Mengmeng Ji16Mengmeng Ji17Mengmeng Ji18Mingxing Xie19Mingxing Xie20Mingxing Xie21Yuman Li22Yuman Li23Yuman Li24Li Zhang25Li Zhang26Li Zhang27Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaClinical Research Center for Medical Imaging in Hubei Province, Wuhan, ChinaHubei Province Key Laboratory of Molecular Imaging, Wuhan, ChinaDepartment of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaClinical Research Center for Medical Imaging in Hubei Province, Wuhan, ChinaHubei Province Key Laboratory of Molecular Imaging, Wuhan, ChinaDepartment of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaClinical Research Center for Medical Imaging in Hubei Province, Wuhan, ChinaHubei Province Key Laboratory of Molecular Imaging, Wuhan, ChinaDepartment of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaClinical Research Center for Medical Imaging in Hubei Province, Wuhan, ChinaHubei Province Key Laboratory of Molecular Imaging, Wuhan, ChinaDepartment of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaClinical Research Center for Medical Imaging in Hubei Province, Wuhan, ChinaHubei Province Key Laboratory of Molecular Imaging, Wuhan, ChinaDepartment of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaClinical Research Center for Medical Imaging in Hubei Province, Wuhan, ChinaHubei Province Key Laboratory of Molecular Imaging, Wuhan, ChinaDepartment of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaClinical Research Center for Medical Imaging in Hubei Province, Wuhan, ChinaHubei Province Key Laboratory of Molecular Imaging, Wuhan, ChinaDepartment of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaClinical Research Center for Medical Imaging in Hubei Province, Wuhan, ChinaHubei Province Key Laboratory of Molecular Imaging, Wuhan, ChinaDepartment of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaClinical Research Center for Medical Imaging in Hubei Province, Wuhan, ChinaHubei Province Key Laboratory of Molecular Imaging, Wuhan, ChinaBackgroundAlthough the left atrium (LA) plays a key role in the pathophysiology and disease progression of heart failure with preserved ejection fraction (HFpEF), the impact of type 2 diabetes mellitus (T2DM) on LA function and stiffness in HFpEF patients remains unclear. Furthermore, the prognostic value of different phases of LA function and stiffness is less well-established in HFpEF patients.MethodsThis study prospectively enrolled 164 HFpEF patients who were in sinus rhythm at the time of echocardiography, including 61 (37%) HFpEF patients with T2DM. LA reservoir, conduit, and pump function were assessed using two-dimensional volume indices and speckle tracking echocardiography. The LA stiffness was calculated as the ratio of early mitral inflow velocity-to-early annular tissue velocity (E/e’) and LA reservoir function. The primary end point was a combined outcome of heart failure hospitalization or death.ResultsLeft atrium reservoir function [measured by peak LA strain (LAS-peak)] and LA pump function (measured by LAS-active) remained significantly lower in the HFpEF patients with T2DM compared with those without T2DM, even after adjustment for potential confounders. In addition, the LA stiffness of HFpEF patients with T2DM was higher than those without T2DM. After a median follow-up of 13.7 months, 46 patients (28.1%) reached the composite end point. LAS-peak (hazard ratios: 0.88; 95% confidence interval: 0.81–0.95; P = 0.001) was significantly associated with the risk of heart failure hospitalization or death after adjusting for demographic and clinical characteristics, LV global longitudinal strain, E/e’, and LA volume index. In contrast, other LA function and stiffness parameters did not independently predict the risk of adverse events. Kaplan-Meier analysis showed that HFpEF patients with T2DM and low LAS-peak (<27.2%) had a significantly increased risk of heart failure-related hospitalization or death (log-rank P < 0.001).ConclusionLeft atrium reservoir and pump function are impaired, whereas LA stiffness is increased in HFpEF patients with T2DM compared with those without T2DM. LAS-peak is a powerful predictor of adverse clinical outcomes and may be crucial for risk stratification in HFpEF patients with and without T2DM.https://www.frontiersin.org/articles/10.3389/fcvm.2022.947639/fullheart failure with preserved ejection fractiontype 2 diabetes mellitusleft atrial functionstiffnessprognosis |
| spellingShingle | Shuangshuang Zhu Shuangshuang Zhu Shuangshuang Zhu Yixia Lin Yixia Lin Yixia Lin Yanting Zhang Yanting Zhang Yanting Zhang Guohua Wang Mingzhu Qian Mingzhu Qian Mingzhu Qian Lang Gao Lang Gao Lang Gao Mengmeng Ji Mengmeng Ji Mengmeng Ji Mingxing Xie Mingxing Xie Mingxing Xie Yuman Li Yuman Li Yuman Li Li Zhang Li Zhang Li Zhang Prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitus Frontiers in Cardiovascular Medicine heart failure with preserved ejection fraction type 2 diabetes mellitus left atrial function stiffness prognosis |
| title | Prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitus |
| title_full | Prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitus |
| title_fullStr | Prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitus |
| title_full_unstemmed | Prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitus |
| title_short | Prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitus |
| title_sort | prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitus |
| topic | heart failure with preserved ejection fraction type 2 diabetes mellitus left atrial function stiffness prognosis |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.947639/full |
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