Assessment Of The Left Atrial Function Of The Type 2 Diabetes Mellitus Patients With Non-alcoholic Fatty Liver Disease By Two-dimensional Speckle Tracking Echocardiography

Objective: The objective of our study was to assess left atrial function in type 2diabetes mellitus(T2DM)patients with nonalcoholic fatty liver disease(NAFLD)by two-dimensional speckle tracking echocardiography(2D-STE).Methods: We recruited inpatients who had been diagnosed T2 DM in our hospital from August 2018 to December 2018.There were 97 recruited patients,aged from 26 to 58 years old,with an average age of(46.9±8.9),69 males and 28 females.The left ventricular ejection fraction(LVEF)of all subjects were in normal range(≥50%).We excluded patients as followed: history of heart disease(ischemic heart disease,valvular heart disease,congenital heart disease,etc),hypertension,cirrhosis,the use of any hypoglycemic drug,history of smoking,diabetes-related complications,carotid artery stenosis,excessive alcohol intake(alcohol consumption: females>20g/d,males>30g/d).These patients totally were divided into Group A(without NAFLD in control group,n=30,age 26-56 years,mean age 48.5±10.0 years,22 males and 8females),Group B(mild fatty liver,n=32,age34-58 years,mean age 45.3±5.4 years,20 males and 12 females)and Group C(moderate to severe fatty liver,n=35,age30-58 years,mean age 47.2±9.7 years,27 males and 8 females),according to the diagnostic criteria of NAFLD.We recorded all the general information of subjects,including gender,age,heart rate(HR),blood pressure(BP),and caculated body mass index(BMI),and body surface area(BSA).In addition,after 10 minutes rest,we measured their biochemical parameters,including aspartate aminotransferases(AST),and alanine aminotransferases(ALT),triglyceride(TG),a total cholesterol(TC),fasting plasma glucose(FPG)and glycosylated hemoglobin(Hb A1c).We used GE Vivid E9 scanner,equipped M5S-D probe(1.7-3.3MHz frame/s)and connected to a synchronous electrocardiogram.And Echo-PAC work station was used for off-line analysis of the 2D-STE parameters of left atrial wall.Echocardiography parameters included left atrial end-systolic diameter(LADs),the left ventricular end-diastolic diameter(LVDd),the left ventricular end-systolic diameter(LVDs),interventricular septum thickness end-diastolic diameter(IVSTd)and the left ventricular posterior wall thickness end-diastolic diameter(PWTd).Transmitral peak early diastolic velocity(E)and peak late diastolic velocity(A).Septal and lateral mitral annular early-diastolic velocity(Sept e’ and Lat e’),then calculated E/A and E/mean e’.We measured LVEF and left atrial volumes(max,min and pre-atrial contraction volume)by Bi-plane Simpson’s rule,then according to the formula,we calculated left atrial passive and active ejection fraction(LAPEF,LAAEF),left atrial maximum volume index(LAVImax).2D-STE parameters included the global peak longitudinal systolic strain rate of the left ventricular(LVSRs),the global peak longitudinal systolic strain(LASRs),early diastolic strain(LASRe)and late diastolic strain(LASRa)rates of the left atrial.Results:1.General information and biochemical parameters:No significant difference was found in age,gender,HR,BP,FPG,TG,TC among three groups(all P>0.05).In group C,BMI,Hb A1 c,ALT and AST were higher than those in group A and B(all P<0.05).In group B,ALT,AST were higher than those in group A(both P<0.05).2.Conventional echocardiography parameters:There were no significant difference in IVSTd,PWTd,LVDd and LVDs among three groups(all P>0.05).In group C,E/A,Sept e’,Lat e’ and LAPEF decreased(all P<0.05),while LADs,E/mean e’,LAVmax,LAVp,LAVmin,LAVImax and LAAEF increased compared with those in group A and B(all P<0.05).3.2D-STE parameters:There was no significant difference between group A and group B(all P>0.05).In group C,LASRa was obviously increased(P<0.05),while LVSRs,LASRe and LASRs were obviously decreased compared with the corresponding values in groups A and B(all P<0.05).4.In the multivariable liner regression analysis,NAFLD is still independent risk factor of left atrial strain rate value in the patients with T2 DM,after adjusting for the potential confounders(BMI、Hb A1c)by establishing a model related to T2 DM.Conclusion:1.The left atrial conduit and resevoir function may decrease,while the booster function may enhance in T2 DM Patients with moderate to severe NAFLD.2.2D-STE can be used to evaluate the left atrial function in T2 DM patients with NAFLD.