GLYCEMIC CONTROL AND LEFT ATRIAL FUNCTION ASSESSED BY STRAIN-BASED ECHOCARDIOGRAPHY
Keywords:
diabetes mellitus, prediabetes, glycemic control, left atrial strain, speckle-tracking echocardiographyAbstract
Introduction: Diabetes mellitus (DM) and prediabetes are associated with adverse cardiac remodeling. Left atrial (LA) strain, assessed by speckle-tracking echocardiography, can detect subtle LA dysfunction before structural changes occur.
Aim: To evaluate the relationship between glycemic control and LA strain in patients with type 2 DM and prediabetes.
Methods: We studied 155 consecutive patients with DM or prediabetes who underwent standard 2D echocardiography and LA strain analysis. Glycemic control was assessed by HbA1c and categorized as good or poor. LA reservoir (PALS) and contractile (PACS) strain were compared between groups. Correlation and multivariate regression analysis were performed to assess association between HbA1c and LA strain.
Results: Patients with poor glycemic control (n = 33) had significantly lower PALS (p=0.012) and higher prevalence of PALS values above the lowest normal (p=0.006) compared to those with good control. HbA1c was positively correlated with the presence of PALS and PACS above the lowest normal value. However, in multivariate regression, poor glycemic control did not retain independent predictive value for impaired LA strain after adjusting for age, BMI, LA volume, and/or LV global longitudinal strain (GLS%) in the whole cohort and in the prediabetic subgroup.
Conclusion: In patients with type 2 diabetes and prediabetes, poor glycemic control is associated with early LA dysfunction, as detected by strain analysis, even in the absence of LA enlargement or overt LV systolic impairment. LA strain may serve as an early marker of subclinical atrial remodeling in dysglycemia.
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Copyright (c) 2025 Ljavdim Ibraimi, Nikola Janev, Marija Bajdevska, Lejla Shabani-Misini, Emilija Antova, Ljubica Georgievska Ismail
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