Evaluation of left atrial function in type 2 diabetes mellitus patients with nonalcoholic fatty liver disease by two‐dimensional speckle tracking echocardiography

Abstract

Objective To assess left atrial function in type 2 diabetes mellitus (T2DM) patients with nonalcoholic fatty liver disease (NAFLD) by two‐dimensional speckle tracking echocardiography (2D‐STE). Methods We classified 97 patients with T2DM into three groups according to the results of liver ultrasonography: group A (without NAFLD), group B (mild fatty liver), and group C (moderate to severe fatty liver). Conventional echocardiography parameters included left atrial end‐systolic diameter (LAD), left ventricular end‐systolic and end‐diastolic diameter (LVDs, LVDd), end‐diastolic thickness of ventricular septumi and LV posterior wall (IVSTd, LVPWTd), peak E and A of mitralis (E, A), septal and lateral early (e′) mitral annular diastolic tissue velocities, then calculated E/A and E/mean e′. We measured LV ejection fraction (LVEF) and left atrial (LA) volumes (max, min, and preatrial contraction volume) by Simpson's rule, then calculated LA passive and active ejection fraction (LAPEF, LAAEF), left atrial maximum volume index (LAVImax). The global peak longitudinal systolic strain (LASRs), early diastolic strain (LASRe), and late diastolic strain (LASRa) rates of the LA were obtained by 2D‐STE. Results No differences were found between groups A and B (all P > 0.05). In group C, LAAEF and LASRa were obviously higher, while LAPEF, LASRe, and LASRs were obviously decreased compared with those values in groups A and B (all P < 0.05). The association between the severity of NAFLD and the differences in LA strain values remained significant after adjustment for confounders. Conclusion Two‐dimensional speckle tracking echocardiography can evaluate the left atrial function in T2DM patients with NAFLD.

Is non-alcoholic fatty liver disease a sign of left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus? A systematic review and meta-analysis

“…Ten observational studies comprising 1800 T2DM participants, of which 1124 (62.4%) T2DM with NAFLD were included 22–31. We assessed the risk of bias in all eligible studies based on the CSSQ checklist, and all studies achieved scores of 7–9 points (see online supplemental table S2).…”

Association of Non-Alcoholic Fatty Liver Disease and Hepatic Fibrosis with Epicardial Adipose Tissue Volume and Atrial Deformation Mechanics in a Large Asian Population Free from Clinical Heart Failure

“…Recently, the large population-based prospective CARDIA Study showed that NAFLD is longitudinally associated with subclinical LV remodeling, abnormal geometry, and impaired LV longitudinal strain after a five-year follow-up [15]. Several small studies have shown that NAFLD is associated with decreased LA strain indices [26,27]. There is a plethora of evidence that supports the adverse effects of NAFLD on diastolic function [28][29][30].…”

Non-Alcoholic Fatty Liver Disease and Risk of Macro- and Microvascular Complications in Patients with Type 2 Diabetes

“…A 2019 meta-analysis of 16 observational studies further confirmed that NAFLD (as detected by imaging techniques or liver biopsy) was independently associated with many functional and structural myocardial abnormalities, including higher left ventricle mass, higher left ventricular end diastolic diameter, higher left atrium diameter and the ratio between left atrial volume and body surface area, higher posterior wall and septum thickness, lower E/A wave ratio, higher E/E ratio, longer deceleration time and longer relaxation time [58]. Interestingly, recent observational studies also indicated that NAFLD (as detected by ultrasonography) was associated with a reduction in global longitudinal strain, which is a relatively novel echocardiographic parameter strongly associated with adverse cardiovascular outcomes [59][60][61]. NAFLD was associated with an increased risk of incident CKD (random-effects hazard ratio 1.43, 95% confidence interval 1.33-1.54)…”