title: Early impairment in left ventricular longitudinal systolic function is associated with an increased risk of incident atrial fibrillation in patients with type 2 diabetes.
abstract: OBJECTIVE
  It is known that type 2 diabetic patients are at high risk of atrial fibrillation (AF). However, the early echocardiographic determinants of AF vulnerability in this patient population remain poorly known.
  
  
  METHODS
  We followed-up for 2years a sample of 180 consecutive outpatients with type 2 diabetes, who were free from AF and ischemic heart disease at baseline. All patients underwent a baseline echocardiographic-Doppler evaluation with tissue Doppler and 2-D strain analysis. Standard electrocardiograms were performed twice per year, and a diagnosis of incident AF was confirmed in affected patients by a single cardiologist.
  
  
  RESULTS
  Over the 2-year follow-up period, 14 (7.8%) patients developed incident AF. In univariate analyses, echocardiographic predictors of new-onset AF were greater indexed cardiac mass, larger indexed left atrial volume (LAVI), lower global longitudinal strain (LSSYS), lower global diastolic strain rate during early phase of diastole (SRE), lower global diastolic strain rate during late phase of diastole (SRL), and higher E/SREratio. Multivariate logistic regression analysis showed that lower LSSYSremained the only significant predictor of new-onset AF (adjusted-odds ratio 1.63, 95%CI 1.17-2.27; p<0.005) after adjustment for age, sex, diabetes duration, indexed cardiac mass and LAVI. Results were unchanged even after adjustment for body mass index, hypertension and glycemic control.
  
  
  CONCLUSIONS
  This is the first prospective study to show that early LSSYSimpairment independently predicts the risk of new-onset AF in type 2 diabetic patients with preserved ejection fraction and without ischemic heart disease. Future larger prospective studies are needed to confirm these findings.
authors.affiliation: Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonapace
authors.affiliation: Division of General Medicine, "Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Valbusa
authors.affiliation: Division of General Medicine, "Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bertolini
authors.affiliation: Division of General Medicine, "Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Zenari
authors.affiliation: Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Canali
authors.affiliation: Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Molon
authors.affiliation: Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Lanzoni
authors.affiliation: Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cecchetto
authors.affiliation: Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mantovani
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zoppini
authors.affiliation: Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Barbieri
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy. Electronic address: giovanni.targher@univr.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Targher
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging / Q000503:physiopathology*; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: Atrial fibrillation; Echocardiography; Global longitudinal strain; Risk factors; Type 2 diabetes