Gong Mingxia, Xu Min, Pan Suoya, Jiang Shu, Jiang Xiaohong
Department of Echocardiography, The Third Affiliated Hospital of Soochow University, 213003 Changzhou, Jiangsu, China.
Department of Cardiology, The Third Affiliated Hospital of Soochow University, 213003 Changzhou, Jiangsu, China.
Rev Cardiovasc Med. 2025 May 21;26(5):27247. doi: 10.31083/RCM27247. eCollection 2025 May.
This study aimed to use four-dimensional automatic left atrial quantification (4D Auto LAQ) to quantitatively evaluate the morphological and functional changes in the left atrium (LA) in asymptomatic type 2 diabetes mellitus (T2DM) patients with early chronic kidney disease (CKD), and explore its correlation with major adverse cardiovascular event (MACE) occurrence.
This study enrolled patients with asymptomatic T2DM complicated with early CKD. Then, 4D-Auto LAQ was used to evaluate LA volume index (minimum, maximum, pre-ejection) and LA longitudinal and circumferential strains during each of the three LA phases: reservoir, conduit, and contraction. The primary endpoint for follow-up was defined as the first occurrence of nonfatal acute myocardial infarction, stroke, congestive heart failure, or cardiac death. Univariate and multivariate Cox proportional hazard analyses were used to evaluate the correlation between LA parameters and the MACEs in T2DM patients with early CKD.
A total of 361 patients were analyzed (mean age, 59.51 ± 11.17 years). During a median follow-up period of 47 months (interquartile range, 17-59 months), MACEs occurred in 70 patients. After adjusting for various clinical and echocardiographic predictors, increased LA volume and impaired reservoir function (ResF) were each independently associated with the primary endpoint: Left atrium minimum volume index (LAVImin) had an adjusted hazard ratio (HR) of 1.21 (95% confidence interval (CI), 1.08-1.35; = 0.010), whereas left atrium longitudinal strain during the reservoir phase (LASr) had an adjusted HR of 0.81 (95% CI, 0.74-0.89; < 0.001). Univariate and multivariate Cox regression analyses indicated that the cumulative incidence of MACEs was significantly greater in patients with LAVImin >16.9 mL/m than in those with LAVImin ≤16.9 mL/m (HR, 2.25; 95% CI, 1.03-6.39; = 0.005). Furthermore, patients with a LASr <18.5% faced a markedly elevated risk of MACEs-nearly fourfold greater than individuals with a LASr ≥18.5% (HR, 3.95; 95% CI, 1.76-8.86; < 0.001).
An enlarged left atrium (LAVImin) and impaired ResF (LASr) are strongly associated with long-term outcomes in T2DM patients complicated with early CKD. LASr showed the strongest associations with the occurrence of MACEs.
本研究旨在使用四维自动左心房定量分析（4D Auto LAQ）定量评估早期慢性肾脏病（CKD）的无症状2型糖尿病（T2DM）患者左心房（LA）的形态和功能变化，并探讨其与主要不良心血管事件（MACE）发生的相关性。
本研究纳入了无症状T2DM合并早期CKD的患者。然后，使用4D-Auto LAQ评估左心房容积指数（最小、最大、射血前期）以及左心房三个阶段（储存期、管道期和收缩期）中每个阶段的左心房纵向和圆周应变。随访的主要终点定义为首次发生非致命性急性心肌梗死、中风、充血性心力衰竭或心源性死亡。采用单因素和多因素Cox比例风险分析评估早期CKD的T2DM患者左心房参数与MACE之间的相关性。
共分析了361例患者（平均年龄59.51±11.17岁）。在中位随访期47个月（四分位间距17 - 59个月）内，70例患者发生了MACE。在调整了各种临床和超声心动图预测因素后，左心房容积增加和储存功能（ResF）受损均与主要终点独立相关：左心房最小容积指数（LAVImin）的调整后风险比（HR）为1.21（95%置信区间（CI），1.08 - 1.35；P = 0.010），而储存期左心房纵向应变（LASr）的调整后HR为0.81（95% CI，0.74 - 0.89；P < 0.001）。单因素和多因素Cox回归分析表明，LAVImin>16.9 mL/m²的患者MACE的累积发生率显著高于LAVImin≤16.9 mL/m²的患者（HR，2.25；95% CI，1.03 - 6.39；P = 0.005）。此外，LASr<18.5%的患者发生MACE的风险显著升高——几乎是LASr≥18.5%的个体的四倍（HR，3.95；95% CI，1.76 - 8.86；P < 0.001）。
左心房扩大（LAVImin）和ResF受损（LASr）与合并早期CKD的T2DM患者的长期预后密切相关。LASr与MACE的发生关联最强。
