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Left atrium volume index is influenced by aortic stiffness and central pulse pressure in type 2 diabetes mellitus patients: A hemodynamic and echocardiographic study

Tomasz Zapolski, Andrzej Wysokiński

Med Sci Monit 2013; 19:153-164

DOI: 10.12659/MSM.883818

Available online:

Published: 2013-03-04

Background: Left atrial volume index (LAVI) has recently emerged as a useful biomarker for risk stratification and risk monitoring in many clinical settings. Many hemodynamic factors such as preload and afterload have an effect on evaluating left atrium function.
This study was performed to investigate the relationship between LAVI and aortic stiffness index (ASI) and selected markers characterizing hemodynamic state in patients with type 2 diabetes mellitus (DM2).
Material and Methods: The study population consisted of 100 patients (56 men, 44 women), 67.2 (±10.9) years old DM2, scheduled for routine coronary angiography. Standard transthoracic echocardiography was used to measure parameters needed for calculation of LAVI and ASI. During invasive procedures, central pulse pressure (CPP) in the ascendens aorta and left ventricle end-diastolic pressure (LVEDP) were recorded. Selected laboratory parameters were obtained, including lipidogram, serum uric acid, hs-CRP, fibrinogen, cTnT, myoglobin, BNP, HbA1C, creatinine, and GFR.
Results: Both LAVI and ASI were greater and CPP and LVEDP were markedly elevated in DM2 patients compared to controls. The independent predictors of LAVI were ASI (ß=0.331; p=0.011), CPP (ß=0.312; p=0.020), LVEDP (ß=0.381; p=0.006), HbA1C (ß=0.379; p=0.008), and BNP (ß=0,423; p<0,001).
Conclusions: The strong correlation between HbA1C and both LAVI and ASI is a sign of negative influence of poor glycemia control on the left ventricle diastolic function and compliance of the aorta. The independent correlation between LAVI and ASI, CPP, and LVEDP improved by association of LAVI and ASI with specific biochemical markers suggests an association between LAVI and elastic properties of the aorta, as well as CPP in DM2 patients.

Keywords: Heart Rate, Heart Atria - ultrasonography, Echocardiography, Diabetes Mellitus, Type 2 - ultrasonography, Coronary Angiography, Case-Control Studies, Blood Pressure, Organ Size, Regression Analysis, Vascular Stiffness