AUTHOR=Zhu Shuangshuang , Lin Yixia , Zhang Yanting , Wang Guohua , Qian Mingzhu , Gao Lang , Ji Mengmeng , Xie Mingxing , Li Yuman , Zhang Li 

TITLE=Prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitus

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.947639

DOI=10.3389/fcvm.2022.947639

ISSN=2297-055X

ABSTRACT=Abstract
Background: Although left atrium (LA) plays a key role in the pathophysiology and disease progression of heart failure with preserved ejection fraction (HFpEF), the impact of type 2 diabetes mellitus (T2DM) on LA function and stiffness in patients with HFpEF remains unclear. Furthermore, the prognostic value of different phases of LA function and stiffness is less well established in HFpEF patients.
Methods: The study prospectively enrolled 164 HFpEF patients who were in sinus rhythm at the time of echocardiography, including 61 (37%) diabetic HFpEF patients. LA reservoir, conduit, and pump function were assessed using two-dimensional volume indices and speckle tracking echocardiography. The LA stiffness was calculated as the ratio of early mitral inflow velocity-to-early annular tissue velocity (E/e’) and LA reservoir function. The primary end point was a combined outcomes of heart failure hospitalization or death. 
Results: LA reservoir function (measured by peak LA strain [LAS-peak]) and LA pump function (measured by LAS-active) remained significantly lower in the HFpEF patients with T2DM compared with those without T2DM, even after adjustment for potential confounders. In addition, LA stiffness of HFpEF patients with T2DM was higher than of those without T2DM. After a median follow-up of 13.7 months, 46 patients (28.1%) reached the composite end point. LAS-peak (hazard ratios: 0.88; 95% confidence interval: 0.81 to 0.95; P = 0.001) was significantly associated with risk of heart failure hospitalization or death after adjusting for demographic and clinical characteristics, LV global longitudinal strain, E/e’ and LA volume index. In contrast, other LA function and stiffness parameters did not independently predict the risk of adverse events. Kaplan-Meier analysis showed that HFpEF patients with T2DM and low LAS-peak (< 27.2 %) had significantly increased risk of heart failure-related hospitalization or death (Log-rank P < 0.001).
Conclusions: LA reservoir and pump function are impaired, whereas LA stiffness is increased in HFpEF patients with T2DM compared with those without T2DM. LAS-peak is a powerful predictor of adverse clinical outcomes and may be crucial for risk stratification in HFpEF patients with and without T2DM.