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Left atrial phasic function and heart rate variability in asymptomatic diabetic patients

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Abstract

Aims

We evaluated left atrial (LA) phasic function and heart rate variability (HRV) in asymptomatic diabetic patients, and the relationship between HRV indices and LA phasic function assessed by volumes and speckle tracking imaging.

Method

This cross-sectional study included 55 asymptomatic patients with type 2 diabetes and 50 healthy controls without cardiovascular risk factors. All study subjects underwent laboratory analyses, complete two-dimensional echocardiography examination (2DE) and 24-h Holter monitoring.

Results

Maximum, minimum LA and pre-A LA volumes and volume indexes are significantly higher in diabetic patients. Total and passive LA emptying fractions (EF), representing the LA reservoir and conduit function, are significantly lower in diabetic subjects. Active LA EF, the parameter of the LA booster pump function, is compensatory increased in diabetic patients. Similar results were obtained by 2DE strain analysis. Cardiac autonomic function, assessed by HRV, is significantly deteriorated in diabetic patients. Time and frequency-domain HRV measures are significantly lower in diabetic subjects than in controls. HbA1c, LV mass index and HRV are associated with total LA EF and longitudinal LA strain independently of age, body mass index and LV diastolic function in the whole study population.

Conclusions

LA phasic function and cardiac autonomic nervous system assessed by HRV are impacted by diabetes. HbA1c and HRV are independently associated with LA reservoir function evaluated by volumetric and strain methods in the whole study population. This study emphasizes the importance of determination of LA function and HRV as important markers of preclinical cardiac damage and autonomic function impairment in diabetic patients.

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Author notes

    Authors and Affiliations

    1. Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Heroja Milana Tepica 1, 11000, Belgrade, Serbia

      Marijana Tadic, Vladan Vukomanovic, Jelena Suzic-Lazic & Vera Celic

    2. Faculty of Medicine, Doktora Subotica 6, 11000, Belgrade, Serbia

      Vera Celic

    3. Clinical Research Unit, Istituto Auxologico Italiano, University of Milan-Bicocca, Viale della Resistenza 23, 20036, Meda, Italy

      Cesare Cuspidi

    4. Institute for Medical Statistics and Informatics, Doktora Subotica 15, 11000, Belgrade, Serbia

      Dejana Stanisavljevic

    Authors
    1. Marijana Tadic
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    2. Vladan Vukomanovic
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    3. Cesare Cuspidi
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    4. Jelena Suzic-Lazic
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    5. Dejana Stanisavljevic
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    6. Vera Celic
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    Correspondence to Marijana Tadic.

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    The authors declare that they have no conflict of interest.

    Human and animal rights

    All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

    Informed consent

    Informed consent was obtained from all patients for being included in the study.

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    Managed by Antonio Secchi.

    Marijana Tadic and Vladan Vukomanovic have contributed equally.

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    Tadic, M., Vukomanovic, V., Cuspidi, C. et al. Left atrial phasic function and heart rate variability in asymptomatic diabetic patients. Acta Diabetol 54, 301–308 (2017). https://doi.org/10.1007/s00592-016-0962-x

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    • DOI: https://doi.org/10.1007/s00592-016-0962-x

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