Xing Yumeng, Zhao Rui, Zhang Xiaoli, Jin Jiamei, Yang Yiming, Wang Haier, Wang Yan, Zhong Chunyan, Chen Lin, Zhang Yinjia
Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.
Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA.
Echocardiography. 2025 May;42(5):e70196. doi: 10.1111/echo.70196.
The 4-dimensional automated left atrial quantification (4D Auto LAQ) technology for the left atrium was recently available. We aimed to evaluate LA function using 4D Auto LAQ in patients with type 2 diabetes mellitus (T2DM) and investigate its value in predicting left ventricular remodeling (LVR).
A total of 106 T2DM patients (56 with left ventricular [LV] remodeling and 50 with normal geometry) and 46 age- and sex-matched controls were enrolled. LA total emptying fraction (LATEF), LA active emptying fraction (LAAEF), LA passive emptying fraction (LAPEF), and strain parameters, including LA reservoir longitudinal/circumferential strain (LASr/LASr-c), LA conduit longitudinal/circumferential strain (LAScd/LAScd-c), and LA contraction longitudinal/circumferential strain (LASct/LASct-c), were assessed with 4D Auto LAQ.
Compared to controls, LASr, LAScd, and LAPEF significantly decreased in both groups of T2DM patients (p < 0.001). T2DM patients with LVR had significantly lower LASr and LAScd than those with normal geometry (p < 0.001). LATEF was also reduced in T2DM patients with LVR compared to the control group (p < 0.05). Among the 4D-LAQ parameters, only LASr (odds ratio [OR]: 0.860, p = 0.016) was associated with LV remodeling (LVR) in multivariate analysis. Receiver operating characteristic (ROC) curves identified a LASr value of ≤22.5% as the optimal cutoff point to predict LVR in the T2DM cohort (sensitivity, 86.0%; specificity, 64.3%; area under the curve [AUC], 0.770; p < 0.001). In addition, LASr was found to be negatively correlated with both LV mass index (LVMI) and relative wall thickness (RWT) but positively correlated with the absolute value of the LV global longitudinal strain (LVGLS).
Impairment of LA reservoir and conduit functions can be observed in patients with T2DM, particularly in those with LVR. LASr may serve as a predictor of LVR in patients with T2DM.
用于左心房的四维自动左心房定量（4D自动LAQ）技术最近已可用。我们旨在使用4D自动LAQ评估2型糖尿病（T2DM）患者的左心房功能，并研究其在预测左心室重构（LVR）中的价值。
共纳入106例T2DM患者（56例左心室[LV]重构患者和50例几何结构正常患者）以及46例年龄和性别匹配的对照者。使用4D自动LAQ评估左心房总排空分数（LATEF）、左心房主动排空分数（LAAEF）、左心房被动排空分数（LAPEF）以及应变参数，包括左心房储存器纵向/周向应变（LASr/LASr-c）、左心房管道纵向/周向应变（LAScd/LAScd-c）和左心房收缩纵向/周向应变（LASct/LASct-c）。
与对照组相比，两组T2DM患者的LASr、LAScd和LAPEF均显著降低（p<0.001）。有LVR的T2DM患者的LASr和LAScd显著低于几何结构正常的患者（p<0.001）。与对照组相比，有LVR的T2DM患者的LATEF也降低（p<0.05）。在4D-LAQ参数中，多变量分析显示只有LASr（比值比[OR]：0.860，p=0.016）与左心室重构（LVR）相关。受试者工作特征（ROC）曲线确定LASr值≤22.5%为预测T2DM队列中LVR的最佳截断点（敏感性为86.0%；特异性为64.3%；曲线下面积[AUC]为0.770；p<0.001）。此外，发现LASr与左心室质量指数（LVMI）和相对壁厚度（RWT）均呈负相关，但与左心室整体纵向应变（LVGLS）的绝对值呈正相关。
在T2DM患者中可观察到左心房储存器和管道功能受损，尤其是在有LVR的患者中。LASr可作为T2DM患者LVR的预测指标。
