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Original investigation
Left Atrial Strain and Diastolic Function Abnormalities in Obese and Type 2 Diabetic Adolescents and Young Adults.
Jeremy Mark Steele
Yale University School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3121-3036
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Cardiovascular Diabetology.
Background: Adults with obesity and type 2 diabetes mellitus (T2DM) related to obesity are at increased risk of heart failure with preserved ejection fraction (HFpEF). Whether left ventricular (LV) diastolic function abnormalities related to obesity and T2DM start in adolescence and early adulthood is unknown. We non-invasively evaluated the differences seen in LV diastolic and left atrial (LA) function in adolescents and young adults with obesity and T2DM.
Methods: We analyzed echocardiographic measures of LV diastolic function in patients with structurally normal hearts which were divided into 3 groups (normal weight, obese, and T2DM). Spectral and tissue Doppler and 2-D speckle tracking measurements of diastolic function were obtained. Logistic regression was performed to compare the prevalence of abnormalities in diastolic function based on the worst 25th percentile for each measure to determine the prevalence of diastolic and LA function abnormalities in obese and T2DM patients.
Results: 331 teenagers and young adults (median age 22.1 years) were analyzed (101 normal weight, 114 obese, 116 T2DM). Obese and T2DM group had lower E/A and higher E/e’. Obese and T2DM patients had significantly lower atrial reservoir, conduit, and booster strain and worse reservoir and conduit strain rate compared to normal patients (p<0.001 for all measures). All patients had normal LA volumes. On multivariable analysis, conduit strain and reservoir and conduit strain rate were independently associated with having below the 25th percentile e’. Conduit strain rate was independently associated with having below the 25th percentile for mitral E/A ratio on multivariable analysis.
Conclusions: Abnormal indices of LV diastolic function are detected in adolescents and young adults with obesity and T2DM. LA function and strain analysis were able to detect evidence of decreased reservoir, conduit, and booster strain in these patients although LA volume was normal. The use of LA function strain may increase our ability to detect early diastolic function abnormalities in this population.
Keywords
Left atrial strain, obesity, type 2 diabetes mellitus, diastolic function
Figure 1
Due to technical limitations, the tables are only available as a download in the supplemental files section.
Table 1. Demographics of the Patient Population
Table 2. Left Atrial Volume and Strain Data and Traditional Diastolic Function Data.
Table 3. Comparison of Abnormal Distribution (Based on the Normal Group) Among Groups.
Table 4. Risk Factors Predicting The Worst 25th Percentile of Diastolic Dysfunction Measures.
Supplemental Table 1. Correlations between Traditional Diastolic Function Measurements and Left Atrial Strain Measurements of the Entire Cohort.
Supplemental Table 2. Correlations between Traditional Diastolic Function Measurements and Left Atrial Strain Measurements of the Normal Weight Patients (n=101)
Supplemental Table 3. Correlations between Traditional Diastolic Function Measurements and Left Atrial Strain Measurements of the Obese Patients (n=114)
Supplemental Table 4. Correlations between Traditional Diastolic Function Measurements and Left Atrial Strain Measurements of T2DM Patients (n=116)
This is a list of supplementary files associated with this preprint. Click to download.
- Table1.pdf
Table 1. Demographics of the Patient Population
- Table2.pdf
Table 2. Left Atrial Volume and Strain Data and Traditional Diastolic Function Data.
- Table3.pdf
Table 3. Comparison of Abnormal Distribution (Based on the Normal Group) Among Groups.
- Table4.pdf
Table 4. Risk Factors Predicting The Worst 25th Percentile of Diastolic Dysfunction Measures.
- Supplementaldata.pdf
Supplemental Table 1. Correlations between Traditional Diastolic Function Measurements and Left Atrial Strain Measurements of the Entire Cohort. Supplemental Table 2. Correlations between Traditional Diastolic Function Measurements and Left Atrial Strain Measurements of the Normal Weight Patients (n=101) Supplemental Table 3. Correlations between Traditional Diastolic Function Measurements and Left Atrial Strain Measurements of the Obese Patients (n=114) Supplemental Table 4. Correlations between Traditional Diastolic Function Measurements and Left Atrial Strain Measurements of T2DM Patients (n=116)
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CURRENT STATUS: Published
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Posted 22 Sep, 2020
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Editorial decision: Major Revision
On 14 Jun, 2020
Review #4 received
Received 27 May, 2020
Review #2 received
Received 27 May, 2020
Review #3 received
Received 27 May, 2020
Review #1 received
Received 18 May, 2020
Reviewer #2 agreed
On 13 May, 2020
Reviewer #3 agreed
On 13 May, 2020
Reviewer #4 agreed
On 13 May, 2020
Reviewer #1 agreed
On 12 May, 2020
Reviewers invited
Invitations sent on 10 May, 2020
Editor assigned
On 09 May, 2020
Submission checks complete
On 08 May, 2020
Editor invited
On 08 May, 2020
First submitted
On 05 May, 2020
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This preprint is under consideration at Cardiovascular Diabetology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Original investigation
Left Atrial Strain and Diastolic Function Abnormalities in Obese and Type 2 Diabetic Adolescents and Young Adults.
Jeremy Mark Steele
Yale University School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3121-3036
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 22 Sep, 2020
No comments provided
Editorial decision: Major Revision
On 14 Jun, 2020
Review #4 received
Received 27 May, 2020
Review #2 received
Received 27 May, 2020
Review #3 received
Received 27 May, 2020
Review #1 received
Received 18 May, 2020
Reviewer #2 agreed
On 13 May, 2020
Reviewer #3 agreed
On 13 May, 2020
Reviewer #4 agreed
On 13 May, 2020
Reviewer #1 agreed
On 12 May, 2020
Reviewers invited
Invitations sent on 10 May, 2020
Editor assigned
On 09 May, 2020
Submission checks complete
On 08 May, 2020
Editor invited
On 08 May, 2020
First submitted
On 05 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Cardiovascular Diabetology.
Background: Adults with obesity and type 2 diabetes mellitus (T2DM) related to obesity are at increased risk of heart failure with preserved ejection fraction (HFpEF). Whether left ventricular (LV) diastolic function abnormalities related to obesity and T2DM start in adolescence and early adulthood is unknown. We non-invasively evaluated the differences seen in LV diastolic and left atrial (LA) function in adolescents and young adults with obesity and T2DM.
Methods: We analyzed echocardiographic measures of LV diastolic function in patients with structurally normal hearts which were divided into 3 groups (normal weight, obese, and T2DM). Spectral and tissue Doppler and 2-D speckle tracking measurements of diastolic function were obtained. Logistic regression was performed to compare the prevalence of abnormalities in diastolic function based on the worst 25th percentile for each measure to determine the prevalence of diastolic and LA function abnormalities in obese and T2DM patients.
Results: 331 teenagers and young adults (median age 22.1 years) were analyzed (101 normal weight, 114 obese, 116 T2DM). Obese and T2DM group had lower E/A and higher E/e’. Obese and T2DM patients had significantly lower atrial reservoir, conduit, and booster strain and worse reservoir and conduit strain rate compared to normal patients (p<0.001 for all measures). All patients had normal LA volumes. On multivariable analysis, conduit strain and reservoir and conduit strain rate were independently associated with having below the 25th percentile e’. Conduit strain rate was independently associated with having below the 25th percentile for mitral E/A ratio on multivariable analysis.
Conclusions: Abnormal indices of LV diastolic function are detected in adolescents and young adults with obesity and T2DM. LA function and strain analysis were able to detect evidence of decreased reservoir, conduit, and booster strain in these patients although LA volume was normal. The use of LA function strain may increase our ability to detect early diastolic function abnormalities in this population.
Figure 1
Due to technical limitations, the tables are only available as a download in the supplemental files section.
Table 1. Demographics of the Patient Population
Table 2. Left Atrial Volume and Strain Data and Traditional Diastolic Function Data.
Table 3. Comparison of Abnormal Distribution (Based on the Normal Group) Among Groups.
Table 4. Risk Factors Predicting The Worst 25th Percentile of Diastolic Dysfunction Measures.
Supplemental Table 1. Correlations between Traditional Diastolic Function Measurements and Left Atrial Strain Measurements of the Entire Cohort.
Supplemental Table 2. Correlations between Traditional Diastolic Function Measurements and Left Atrial Strain Measurements of the Normal Weight Patients (n=101)
Supplemental Table 3. Correlations between Traditional Diastolic Function Measurements and Left Atrial Strain Measurements of the Obese Patients (n=114)
Supplemental Table 4. Correlations between Traditional Diastolic Function Measurements and Left Atrial Strain Measurements of T2DM Patients (n=116)