Left atrial volume index: relation to long-term clinical outcome in type 2 diabetes.
OBJECTIVE
The study sought to determine the prognostic importance of left atrial (LA) dilation in patients with type 2 diabetes mellitus (T2DM) and no history of cardiovascular disease (CVD).


BACKGROUND
T2DM is associated with the development of CVD, and morphological changes in the heart may appear before symptoms arise.


METHODS
A total of 305 T2DM patients without known CVD referred to a diabetes clinic were included consecutively (age 58.6 ± 11.3 years, diabetes duration 2.0 [interquartile range: 0 to 6.0] years). Each patient underwent a comprehensive echocardiogram and a myocardial perfusion scintigraphy (MPS) at inclusion. Patients were divided according to left atrial volume index (LAVi) ≥32 ml/m(2). Patients were followed for median of 5.6 (interquartile range: 5.1 to 6.1) years for the occurrence of major cardiac events and death.


RESULTS
LAVi ≥32 ml/m(2) was found in 105 patients (34%). During follow-up, 60 patients (20%) experienced the composite endpoint, of whom 28 (9%) died. Patients with LAVi ≥32 ml/m(2) had a significantly higher cardiac event rate and death rate (p < 0.001 and p = 0.002, respectively). Univariate predictors of the composite endpoint were age, hypertension, left ventricular diastolic function, E/e'septum-ratio and LAVi ≥32 ml/m(2); however, myocardial ischemia on MPS was not a predictor. When adjusting for age and hypertension, only LAVi ≥32 ml/m(2) was a predictor of the composite endpoint (hazard ratio: 1.82 [95% confidence interval: 1.08 to 3.07], p = 0.024).


CONCLUSIONS
Increased LAVi was an independent and incremental predictor of cardiovascular morbidity and mortality in T2DM patients with no history of CVD. (Presence of Macrovascular Disease in Type 2 Diabetes Mellitus; NCT00298844).
Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: doc_mkp@hotmail.com.
Mikael K
MK
Poulsen
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Jordi S
JS
Dahl
Department of Endocrinology, Odense University Hospital, Odense, Denmark.
Jan Erik
JE
Henriksen
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Thomas M
TM
Hey
Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
Poul Flemming
PF
Høilund-Carlsen
Department of Endocrinology, Odense University Hospital, Odense, Denmark.
Henning
H
Beck-Nielsen
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Jacob E
JE
Møller
D000368:Aged; D016279:Atrial Function, Left / Q000502:physiology*; D002306:Cardiac Volume / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome
CVD; LAVi; LV; MACE; MPS; SSS; T2DM; cardiovascular disease; clinical outcome; echocardiography; left atrial volume index; left ventricular; major cardiovascular event(s); myocardial perfusion scintigraphy; summed stress score; type 2 diabetes mellitus