Left atrial volume index as a marker of left ventricular diastolic dysfunction in asymptomatic Tanzanian diabetic patients

Figures & data

Table I. Demographic characteristics and laboratory findings in type 1 and type 2 diabetic patients divided into groups with normal and enlarged left atrium volume indexed to body surface area (LAVI).

	Type 1			Type 2
Variable	Normal LAVI (n = 43)	Increased LAVI (n = 15)	p-value	Normal LAVI (n = 68)	Increased LAVI (n = 54)	p-value
Diabetes duration (years)	6.9 ± 3.1	10.5 ± 6.4	0.088	10.2 ± 5.5	11.1 ± 6.3	0.811
Height (cm)	151 ± 12	149 ± 19	0.002	161 ± 7	160 ± 8	0.288
Weight (kg)	47.3 ± 13.0	49.9 ± 19.6	0.024	72.9 ± 12.5	72.7 ± 12.4	0.923
Body mass index (kg/m^2)	20.3 ± 3.5	21.4 ± 5.1	0.251	28.2 ± 4.4	28.7 ± 5.3	0.456
Obesity (%)	0	7	0.385	33	43	0.245
Waist circumference (cm)	72 ± 9	78 ± 18	0.471	97 ± 11	99 ± 11	0.369
Systolic blood pressure (mmHg)	113 ± 15	122 ± 27	0.945	144 ± 18	153 ± 25	0.062
Diastolic blood pressure (mmHg)	72 ± 12	76 ± 19	0.864	88 ± 11	88 ± 12	0.765
Hypertension (%)	12	29	0.602	82	87	0.960
Antihypertensive treatment (%)	2	21	0.098	14	17	0.584
Insulin use (%)	100	100	–	18	24	0.382
Oral hypoglycaemic drugs use (%)	0	0	–	81	74	0.368
Pulse pressure (mmHg)	41 ± 11	46 ± 10	0.705	55 ± 15	65 ± 18	0.008
Mean arterial pressure (mmHg)	86 ± 12	91 ± 21	0.918	107 ± 12	110 ± 15	0.420
HbA1c (%)	11.3 ± 2.0	10.0 ± 2.2	0.142	10.2 ± 2.2	9.4 ± 2.4	0.124
Serum creatinine (µmol/l)	75 ± 40	113 ± 125	0.286	97 ± 31	118 ± 110	0.212
Estimated GFR (ml/min/1.73 m^2)	116 ± 48	87 ± 35	0.033	82 ± 24	78 ± 27	0.707
Abnormal albuminuria (%)	42	36	0.641	38	32	0.443

HbA_1c, haemoglobin A_1c; GFR, glomerular filtration rate.

Figure 1. Prevalence of increased left atrium volume index (LAVI) in different subgroups of patients: (1) normotensive patients (NT) with normal peak early transmitral jet velocity to mitral annulus velocity ratio (E/E’), (2) hypertensive patients (HT) with normal E/E’ and (3) patients with increased E/E’ (presence of left ventricular diastolic dysfunction) according to type of diabetes.

Table II. Echocardiographic findings in type 1 and type 2 diabetic patients divided into groups with normal and increased left atrium volume index (LAVI).

		Type 1		Type 2
Variable	Normal LAVI (n = 43)	Increased LAVI (n = 15)	p-value	Normal LAVI (n = 68)	Increased LAVI (n = 54)	p-value
Left atrial diameter (cm)	2.9 ± 0.4	3.2 ± 0.6	0.464	3.2 ± 0.34	3.5 ± 0.5	< 0.001
Indexed LA (cm/m^2)	2.1 ± 0.3	2.3 ± 0.5	< 0.001	1.8 ± 0.2	2.0 ± 0.3	< 0.001
Left atrial volume (ml)	31 ± 9	55 ± 22	< 0.001	40 ± 7	67 ± 19	< 0.001
LAVI (ml/m^2)	22 ± 5	38 ± 10	< 0.001	23 ± 4	38 ± 10	< 0.001
Intraventricular septum (cm)	0.88 ± 0.15	0.91 ± 0.23	0.264	1.23 ± 0.28	1.31 ± 0.35	0.509
Posterior wall (cm)	0.76 ± 0.14	0.85 ± 0.19	0.844	1.00 ± 0.23	1.10 ± 0.28	0.135
LV end diastolic diameter (cm)	3.92 ± 0.51	4.27 ± 0.89	0.514	4.12 ± 0.49	4.33 ± 0.64	0.017
LV ejection fraction (%)	66 ± 5	61 ± 10	0.114	65 ± 8	63 ± 8	0.313
LV mass index (g/m^2.7)	31.0 ± 7.7	39.1 ± 12.4	0.031	44 ± 12	55 ± 19	0.001
LV hypertrophy (%)	5	27	0.050	30	57	0.008
E (m/s)	94 ± 14	95 ± 14	0.100	67 ± 16	75 ± 20	0.006
A (m/s)	65 ± 14	68 ± 20	0.893	78 ± 14	82 ± 18	0.322
E/A ratio	1.50 ± 0.33	1.55 ± 0.58	0.045	0.87 ± 0.23	0.96 ± 0.45	0.044
Deceleration time (ms)	160 ± 40	158 ± 21	0.453	205 ± 53	204 ± 63	0.738
Isovolumic relaxation time (ms)	62 ± 13	63 ± 21	0.373	82 ± 18	80 ± 22	0.278
E’ (m/s)	10.3 ± 2.2	10.4 ± 2.5	0.360	6.7 ± 2.3	6.1 ± 2.4	0.596
E/E’	9.4 ± 2.4	9.5 ± 2.1	0.895	10.5 ± 2.9	13.6 ± 5.6	0.002
E/E’ ≥ 15 (%)	2	7	0.657	9	35	0.002
Mitral regurgitation (%)	14	40	0.148	21	43	0.015

LV, left ventricular; LA, left atrium; E, peak early transmitral jet; A, peak transmitral jet velocity during atrial contraction; E’, peak early mitral annular velocity.

Table III. Correlates of larger left atrium volume index (LAVI) in the total population and in groups of patients with type 1 and type 2 diabetes.

	Total population (n = 180)		Type 1 (n = 58)		Type 2 (n = 122)
Variable	Pearson's correlation	p-value	Pearson's correlation	p-value	Pearson's correlation	p-value
Age (years)	0.25	0.001	0.41	0.001	0.13	0.153
Duration of diabetes (years)	0.24	0.001	0.53	< 0.001	0.12	0.176
Height (cm)	0.09	0.238	0.03	0.812	0.03	0.758
Weight (kg)	0.16	0.028	0.12	0.158	0.02	0.837
Body mass index (kg/m^2)	0.16	0.031	0.23	0.082	0.02	0.821
Waist circumference (cm)	0.17	0.023	0.22	0.091	0.01	0.934
Systolic BP (mmHg)	0.41	< 0.001	0.31	0.017	0.41	< 0.001
Diastolic BP (mmHg)	0.26	0.001	0.24	0.067	0.19	0.041
Pulse pressure (mmHg)	0.40	< 0.001	0.24	0.067	0.41	< 0.001
Mean BP (mmHg)	0.35	< 0.001	0.28	0.031	0.33	< 0.001
HbA1c (%)	− 0.26	< 0.001	− 0.30	0.021	− 0.21	0.019
Serum creatinine (µmol/l)	0.46	< 0.001	0.55	< 0.001	0.40	< 0.001
Estimated GFR (ml/min/1.73 m^2)	− 0.26	0.001	− 0.28	0.034	− 0.18	0.047
Intraventricular septum (cm)	0.18	0.017	0.04	0.792	0.13	0.164
Posterior wall thickness (cm)	0.24	0.001	0.19	0.148	0.19	0.033
LV ejection fraction (%)	− 0.28	< 0.001	− 0.59	< 0.001	− 0.15	0.110
LV mass index (g/m^2.7)	0.48	< 0.001	0.57	< 0.001	0.44	< 0.001
E/E’	0.47	< 0.001	0.30	0.022	0.49	< 0.001

BP, blood pressure; HbA_1c, haemoglobin A_1c; GFR, glomerular filtration rate; LV, left ventricular; E/E’, peak early transmitral jet velocity to mitral annulus velocity ratio.

Figure 1. Relationship between left atrium volume index (LAVI) and peak early transmitral jet velocity to mitral annulus velocity ratio (E/E’) in type 1 and type 2 diabetic patients.

Table IV. Independent predictors of left atrium volume index (LAVI) in type 1 and type 2 diabetic patient groups identified in multivariate linear regression analyses.

	Type 2 diabetes group (R^2 = 0.34, p < 0.001)		Type 1 diabetes group (R^2 = 0.58, p < 0.001)
Variable	β	p-value	β	p-value
LV diastolic dysfunction	0.20	0.035	0.15	0.223
LV mass index (g/m^2.7)	0.23	0.026	0.30	0.030
LV ejection fraction (%)	0.01	0.945	− 0.37	0.001
Mitral regurgitation	0.25	0.002	0.07	0.536
Systolic blood pressure (mmHg)	0.16	0.108	0.12	0.386
Obesity	0.03	0.741	0.07	0.564
Age (years)	0.07	0.420	0.20	0.146
HbA1c (%)	− 0.09	0.272	− 0.12	0.249

LV, left ventricular; HbA_1c, haemoglobin A_1c.

Figure 1. Enlarged left atrium volume index (LAVI) was associated with left ventricular (LV) diastolic dysfunction independent of presence of LV hypertrophy. Receiver operating characteristic (ROC) curve showing predicted probability of the multivariate logistic regression model with and without LV hypertrophy in the model.

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