Increased Left Atrial Stiffness is Significantly Associated with Paroxysmal Atrial Fibrillation in Diabetic Patients

Figures & data

Figure 1 Two-dimensional speckle tracking ultrasound of the left atrium.

Table 1 Baseline Clinical Characteristics of Diabetic Patients with and without Atrial Fibrillation

	Diabetes with PAF	Diabetes without PAF	P value
	n = 30	n = 30
BMI (Kg/m2)	33.6 ± 5.2	31.8 ± 1.6	0.07
Obesity n (%)	7 (23)	5 (18)	0.63
CAD	20 (68)	17 (57)	0.38
HTN	25 (82)	23 (76)	0.57
HFpEF	13 (43)	12 (40)	0.81
History of stroke/TIA	1 (3)	0 (0)	0.27
Dyslipidemia	17 (56)	16 (53)	0.81
Smoking (current, %)	2 (9)	3 (10)	0.89
Systolic BP (mmHg)	143±15	141±16	0.61
Diastolic BP (mmHg)	85.4±11	82.7 ±9	0.30
Heart rate (beats/min)	85.1±13	79.6±13	0.20
ABI	1.09±0.19	1.13±0.17	0.39
Total cholesterol (mg/dL)	174±40	183±62	0.50
HDL (mg/dL)	40.5 ± 10.2	44.0±14.7	0.28
LDL (mg/dL)	129.4±31	130.5±30	0.88
Triglyceride (mgl/dL)	172.14±57	158.7±69	0.41
FPG (mg/dL)	153.6±50	161.1 ±61	0.50
HbA1c (%)	7.1±0.9	6.9±0.7	0.34
ASAT (U/L)	24±9	23±5	0.59
ALAT (U/L)	37±7	36±5	0.52
NT-proBNP (pg/mL)	412.2±248	344.0±266	0.24
eGFR	62.5±6	63.7±9	0.54
CHA2DS2-VASc score (mean ± 1 SD)	4.6±1.5	4.2±1.2	0.23
0–1	5 (17)	9 (31)
≥2	25 (83)	21 (69)	0.20
LVEF	48.5±6.2	47.7±6.1	0.64
Duration of diabetes (years)	6.5±4	5.3±2	0.14
Diabetes treatment
● Oral antidiabetic drugs	21 (70%)	19 (62%)	0.51
● Insulin	8 (25%)	10 (30%)	0.66
● SGLT2i	5 (18)	6 (21)	0.77
Statins	15 (60)	17 (57)	0.81
Beta blockers	24 (82)	24 (80)	0.84
ACE-i/ARB	48 (80)	23 (75)	0.64
CCB	10 (33)	12 (40)	0.57
Diuretics	16 (52)	14 (48)	0.75
ASA	5 (17)	16 (52)	<0.0001
Clopidogrel	15 (51)	14 (48)	0.81
Acenocumarol	30 (100)	0 (0)	<0.0001
Amiodarone	10 (32)	0 (0)	<0.001

Notes: The data is given as a mean, standard deviation, or number (percentage).

Abbreviations: ABI, ankle brachial index; ACEI, angiotensin converting enzyme inhibitors; AF, atrial fibrillation; ALAT, alanine amino transferase; ARB, angiotensin-1 receptor blockers; ASA, Aspirin; ASAT, aspartate amino-transferase; BMI, body mass index; BP, blood pressure; CAD, coronary artery disease; CCB, calcium channel blocker; CHA₂DS₂-VASc, congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74, sex category (female); FPG, fasting plasma glucose; eGFR, estimated glomerular filtration rate; HbA1c, glycosylated hemoglobin; HDL, high density lipoprotein; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HTN, hypertension; LDL, low density lipoprotein; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal pro- brain type natriuretic peptides; U, units; SGLT2i, sodium-glucose cotransporter-2 inhibitors; TIA, transient ischemic attack.

Table 2 Echocardiography Parameters in Diabetic Patients

	Diabetes with PAF	Diabetes without PAF	P value
	n = 30	n = 30
LVEDV (mL)	97.8±21.0	102.5±17.9	0.34
LVESD (mL)	46.1 ± 10.2	49.3±12.6	0.28
LVMI (g/m2)	143 ± 41	139 ± 35	0.68
LVEF (%)	57 ± 2	60 ± 14	0.25
Mitral E/A-ratio	1.3 ± 0.4	1.2 ± 0.2	0.22
Septal E/E´ average ratio	13.9 ± 4.2	13.1 ± 3.6	0.43
TAPSE (cm)	2.5 ± 0.43	2.4 ± 0.49	0.40
GLS (%)	−14.4 ± 3.1	−15.2 ± 3.2	0.32
LAVI (mL/m2)	42.1 ± 9.3	43.5 ± 10.3	0.58
LAEF (%)	47.7 ± 4.7	49.7 ± 5.9	0.15
LA global strain (%)	14.9 ± 1.9	16.8 ± 2.5	<0.01
LA-pool strain (%)	20.0 ± 4.3	23.8 ± 3.6	<0.001
LA- pump strain (%)	9.6 ± 3.0	12.3 ± 3.4	<0.01
LAsf (%)	0.42±0.09	0.35±0.11	0.02

Abbreviations: LVEDV, left ventricular end diastolic volume; LVESV, left ventricular end systolic volumes; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; E, peak transmitral early diastolic inflow; A, peak transmitral late diastolic inflow; TAPSE, tricuspid annular plane systolic excursion, GLS, global longitudinal strain, LA, left atrium; LAVI, indexed left atrial volume; LAEF, left atrial total emptying fraction; LAsf, left atrial stiffness.

Figure 2 Comparison of left atrial echocardiographic measurements in diabetic patients with and without paroxysmal atrial fibrillation.

Abbreviations: LA, left atrium; PAF, paroxysmal atrial fibrillation; LAS, left atrial global strain; LAsf, left atrial stiffness.

Table 3 Predictors of Paroxysmal Atrial Fibrillation in Diabetic Patients

Parameter	Univariate Analysis OR (95% CI)	P value	Multivariate Analysis OR (95% CI)	P value
LAS	0.73 (0.56–0.96)	0.02	0.58 (0.37–0.92)	0.02
LA-pool strain	0.78 (0.64–0.94)	<0.01	0.74 (0.58–1.95)	0.018
LA- pump strain	0.78 (0.64–0.94)	<0.01	0.68 (0.50–0.94)	0.019
LAsf	0.73 (0.56–0.96)	0.01	5.2 (4.05–7.17)	0.007

Abbreviations: OR, Odds ratio; CI, confidence interval; LAS, left atrial global strain; LAsf, left atrial stiffness.

Figure 3 Comparison of the ROC curves of LA strain parameters associated with PAF in diabetic patients.

Abbreviations: ROC, receiver operating curve; LA, left atrial; LAS, left atrial global strain; PAF, paroxysmal atrial fibrillation.

Figure 4 ROC curve analysis for LAsf as independent predictor of PAF in diabetic patients.

Abbreviations: ROC, receiver operating curve; AUC, area under the curve; LAsf, left atrial stiffness; PAF, paroxysmal atrial fibrillation.