Early impairment in left ventricular longitudinal systolic function is associated with an increased risk of incident atrial fibrillation in patients with type 2 diabetes

J Diabetes Complications. 2017 Feb;31(2):413-418. doi: 10.1016/j.jdiacomp.2016.10.032. Epub 2016 Nov 3.


Aims: It is known that type 2 diabetic patients are at high risk of atrial fibrillation (AF). However, the early echocardiographic determinants of AF vulnerability in this patient population remain poorly known.

Methods: We followed-up for 2years a sample of 180 consecutive outpatients with type 2 diabetes, who were free from AF and ischemic heart disease at baseline. All patients underwent a baseline echocardiographic-Doppler evaluation with tissue Doppler and 2-D strain analysis. Standard electrocardiograms were performed twice per year, and a diagnosis of incident AF was confirmed in affected patients by a single cardiologist.

Results: Over the 2-year follow-up period, 14 (7.8%) patients developed incident AF. In univariate analyses, echocardiographic predictors of new-onset AF were greater indexed cardiac mass, larger indexed left atrial volume (LAVI), lower global longitudinal strain (LSSYS), lower global diastolic strain rate during early phase of diastole (SRE), lower global diastolic strain rate during late phase of diastole (SRL), and higher E/SRE ratio. Multivariate logistic regression analysis showed that lower LSSYS remained the only significant predictor of new-onset AF (adjusted-odds ratio 1.63, 95%CI 1.17-2.27; p<0.005) after adjustment for age, sex, diabetes duration, indexed cardiac mass and LAVI. Results were unchanged even after adjustment for body mass index, hypertension and glycemic control.

Conclusions: This is the first prospective study to show that early LSSYS impairment independently predicts the risk of new-onset AF in type 2 diabetic patients with preserved ejection fraction and without ischemic heart disease. Future larger prospective studies are needed to confirm these findings.

Keywords: Atrial fibrillation; Echocardiography; Global longitudinal strain; Risk factors; Type 2 diabetes.

MeSH terms

  • Aged
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / diagnostic imaging
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / etiology
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Cardiomyopathies / diagnostic imaging
  • Diabetic Cardiomyopathies / physiopathology*
  • Early Diagnosis
  • Echocardiography, Doppler
  • Female
  • Follow-Up Studies
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / physiopathology*
  • Humans
  • Incidence
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Pilot Projects
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Factors
  • Stroke Volume
  • Ventricular Dysfunction, Left / complications*
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / physiopathology