Impact of Type 2 Diabetes Mellitus on Left Atrioventricular Coupling and Left Atrial Deformation in Patients with Essential Hypertension: An MRI Feature Tracking Study

Abstract

BackgroundHypertension (HTN) and type 2 diabetes mellitus (T2DM) are both associated with left ventricular (LV) and left atrial (LA) structural and functional abnormalities; however, the relationship between the left atrium and ventricle in this population is unclear.PurposeTo identify differences between hypertensive patients with and without T2DM as the basis for further investigation the atrioventricular coupling relationship.Study TypeCross‐sectional, retrospective study.Population89 hypertensive patients without T2DM [HTN (T2DM−)] (age: 58.4 +/− 11.9 years, 48 male), 62 hypertensive patients with T2DM [HTN (T2DM+)] (age: 58.5 +/− 9.1 years, 32 male) and 70 matched controls (age: 55.0 +/− 9.6 years, 37 male).Field Strength/Sequence2D balanced steady‐state free precession cine sequence at 3.0 T.AssessmentLA reservoir, conduit, and booster strain (εs, εe, and εa) and strain rate (SRs, SRe, and SRa), LV radial, circumferential and longitudinal peak strain (PS) and peak systolic strain rate and peak diastolic strain rate (PSSR and PDSR) were derived from LA and LV cine images and compared between groups.Statistical TestsChi‐square or Fisher's exact test, one‐way analysis of variance, analysis of covariance, Pearson's correlation, multivariable linear regression analysis, and intraclass correlation coefficient. A P value <0.05 was considered significant.ResultsCompared with controls, εs, εe, SRe and PS‐longitudinal, PDSR‐radial, and PDSR‐longitudinal were significantly lower in HTN (T2DM−) group, and they were even lower in HTN (T2DM+) group than in both controls and HTN (T2DM−) group. SRs, εa, SRa, as well as PS‐radial, PS‐circumferential, PSSR‐radial, and PSSR‐circumferential were significantly lower in HTN (T2DM+) compared with controls. Multivariable regression analyses demonstrated that: T2DM and PS‐circumferential and PS‐longitudinal (β = −4.026, −0.486, and −0.670, respectively) were significantly associated with εs; T2DM and PDSR‐radial and PDSR‐circumferential were significantly associated with εe (β = −3.406, −3.352, and −6.290, respectively); T2DM and PDSR‐radial were significantly associated with SRe (β = 0.371 and 0.270, respectively); T2DM and PDSR‐longitudinal were significantly associated with εa (β = −1.831 and 5.215, respectively); and PDSR‐longitudinal was significantly associated with SRa (β = 1.07).Data ConclusionIn hypertensive patients, there was severer LA dysfunction in those with coexisting T2DM, which may be associated with more severe LV dysfunction and suggests adverse atrioventricular coupling.Evidence Level3.Technical EfficacyStage 3.