Assessment of Echocardiography-Derived Total Atrial Activation Time at Patients with Type 2 Diabetes Mellitus

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  •   Atilla Rexhepi

  •   Valon Asani

  •   Hysni Ismaili

  •   Fisnik Demiri

  •   Vlora Ibrahimi

  •   Ylber Jani

Abstract

Objectives: Atrial fibrillation (AF) is one of the main cardiovascular complications associated with type 2 diabetes mellitus (T2DM). Echocardiography-derived total atrial activation time (PA-TDI duration) which reflects electrical and structural changes to the atria, consistently and accurately predicts new-onset AF. In this study, we aimed to determine the value of PA-TDI duration in T2DM patients.


Methods:  A total of 40 consecutive patients with T2DM, mean age 51.5 ± 14.3 years, and 40 age and gender-matched healthy volunteers were evaluated. Conventional and tissue Doppler echocardiography were performed. Additionally, we determined the PA-TDI duration as the time interval from the onset of the P-wave in lead II of the ECG to the peak A’-wave on the tissue Doppler tracing.


Results: Left atrial (LA) diameter and LA volume index were significantly higher in T2DM patients (3.36 ± 0.5 cm vs.3.10 ± 0.45cm, p=0.037; 30.8 ± 30ml/m2 vs. 29.0 ± 3.4ml/m2, p=0.03 respectively). Mitral A velocity was significantly higher in T2DM patients (69.72 ± 10.16 cm/s vs. 64.75 ± 10.64 cm/s, p=0.029).  Doppler E/A ratio was lower in T2DM patients.  Tissue Doppler E’/A’ ratio for left ventricular lateral annulus was significantly lower in the diabetic group (1.28±0.33 vs. 1.49±0.40, p=0.024) and E/E’ was significantly higher in the diabetic group (7.33±2.5 vs. 6.45±1.1, p=0.038). PA-TDI duration was significantly higher in the T2DM patients when compared with the controls (134.2±6.0ms vs. 124.3±9.4ms p<0.001).


Conclusions: Our results showed that PA-TDI duration is significantly increased in patients with T2DM as compared with healthy volunteers. PA-TDI duration measurement, using transthoracic echocardiography can serve as an easy and non-invasive method of detecting patients with T2DM at risk of atrial fibrillation.


Keywords: Atrial fibrillation, diabetes mellitus, total atrial activation time

References

Ryden L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, et al. DESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes(EASD). Eur Heart J. 2013; 34(39): 3035-87.

Benjamin EJ, Levy D, Vaziri SM, DeAgostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994; 271(11): 840–4.

Movahed MR, Hashemzadeh M, Jamal MM. Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardio-vascular disease. Int J Cardiol 2005; 105: 315–8.

Huxley RR, Filion KB, Konety S, Alonso A. Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol. 2011; 108(1): 56-62.

Allen Wang, Jennifer B. Green, Jonathan L. Halperin, Jonathan P. Piccini, Atrial Fibrillation and Diabetes Mellitus: JACC. 2019; 74(8): 1107-1115.

Qi W, Zhang N, Korantzopoulos P, Letsas KP, Cheng M, Di F, et al. Serum glycated hemoglobin level as a predictor of atrial fibrillation: A systematic review with meta-analysis and meta-regression. PLoS ONE. 2017; 12(3): e0170955.

Chao TF, Sung SH, Wang KL, et al. Associations between the atrial electromechanical interval, atrial remodelling and outcome of catheter ablation in paroxysmal atrial fibrillation. Heart, 2011; 97(3): 225–230.

Chang SL, Tai CT, Lin YJ, Wongcharoen W, Lo LW, Tuan TC, et al. Biatrial substrate properties in patients with atrial fibrillation. J Cardiovasc Electrophysiol. 2007; 18(11): 1134–1139.

Cui QQ, Zhang W, Wang H, Sun X, Wang R, Yang HY, et al. Assessment of atrial electromechanical coupling and influential factors in nonrheumatic paroxysmal atrial fibrillation. Clinical Cardiology: An International Indexed and Peer‐Reviewed Journal for Advances in the Treatment of Cardiovascular Disease. 2008; 31(2): 74-78.

Vatan MB, Yilmaz S, Agac MT, Cakar MA, Erkan H, Aksoy M, et al. Relationship between CHA2DS2-VASc score and atrial electromechanical function in patients with paroxysmal atrial fibrillation: a pilot study. J Cardiol. 2015.

Den Uijl DW, Gawrysiak M, Tops LF, Trines SA, Zeppenfeld K, Schalij MJ, et al. Prognostic value of total atrial conduction time estimated with tissue Doppler imaging to predict the recurrence of atrial fibrillation after radiofrequency catheter ablation. Europace. 2011; 13(11): 1533–40

Müller P, Weijs B, Bemelmans NMAA, Mügge A, Eckardt L, Crijns HJGM, Bax JJ, Linz D, den Uijl DW. Echocardiography-derived total atrial conduction time (PA-TDI duration): risk stratification and guidance in atrial fibrillation management. Clin Res Cardiol. 2021; 110(11): 1734-1742.

Merckx KL, De Vos CB, Palmans A, Habets J, Cheriex EC, Crijns HJ, et al. Atrial activation time determined by transthoracic Doppler tissue imaging can be used as an estimate of the total duration of atrial electrical activation. J Am Soc Echocar- diogr. 2005; 18: 940–944

Müller P, Hars C, Schiedat F, Bösche LI, Gotzmann M, Strauch J, et al. Correlation between total atrial conduction time estimated via tissue Doppler imaging (PA-TDI Interval), structural atrial remodeling and new-onset of atrial fibrillation after cardiac surgery. J Cardiovasc Electrophysiol. 2013; 24(6): 626-31.

Takahashi S, Fujiwara M, Watadani K, Taguchi T, Katayama K, Takasaki T, et al. Preoperative tis sue Doppler imaging-derived atrial conduction time can predict postoperative atrial fibrillation in patients undergoing aortic valve replacement for aortic valve stenosis. Circ J. 2014; 78: 2173–2181

Takahashi S, Katayama K, Watanabe M, Kodama H, Taguchi T, Kurosaki T, et al. Preoperative tissue Doppler imaging-derived atrial conduction time predicts postoperative atrial fibrillation in patients undergoing mitral valve surgery for mitral valve regurgitation. Circ J. 2016; 80: 101–109

Fujiwara M, Nakano Y, Hidaka T, Oda N, Uchimura Y, Sairaku A, et al. Prediction of atrial fibrillation after off-pump coronary artery bypass grafting using preoperative total atrial conduction time determined on tissue Doppler imaging. Circ J. 2014; 78: 345–352

Bertini M, Borleffs CJ, Delgado V, Ng AC, Piers SR, Shanks M, et al. Prediction of atrial fibrillation in patients with an implantable cardioverter-defibrillator and heart failure. Eur J Heart Fail. 2010; 12: 1101–1110

Ejima K, Kato K, Arai K, Fukushima K, Fukushima N, Suzuki T, et al. Impact of atrial remodeling on the outcome of radiofrequency catheter ablation of paroxysmal atrial fibrillation. Circ J. 2014; 78: 872–877

van der Hulst AE, Roest AA, Holman ER, Vliegen HW, Haze- kamp MG, Bax JJ, et al. Relation of pro- longed tissue Doppler imaging-derived atrial conduction time to atrial arrhythmia in adult patients with congenital heart disease. Am J Cardiol. 2012; 109: 1792–1796.

Nattel S, Burstein B, Dobrev D. Atrial remodeling and atrial fibrillation: mechanisms and implications. Circ Arrhythm Electrophysiol. 2008; 1: 62–73

de Vos CB, Weijs G, Crijns HJ, Cheriex EC, Palmans A, Habets J, et al. Atrial tissue Doppler imaging for prediction of new onset atrial fibrillation. Heart. 2009; 95(10): 835–40.

Boyer JK, Thanigaraj S, Schechtman KB, Pe´rez JE. Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Am J Cardiol. 2004; 93: 870–5.

Teupe C, Rosak C. Diabetic cardiomyopathy and diastolic heart failure-difficulties with relaxation. Diabetes Res Clin Pract 2010; 97: 185–94.

Delgado V, Bax JJ. Diastolic dysfunction and atrial fibrillation. Heart 2015; 101: 1263-1264

Akyel A, Oksüz F, Karadeniz M, Yarlıoğlueş M, Ergün G, Cankurt T, et al. Atrial electromechanical delay in type 2 diabetes mellitus. Wien Klin Wochenschr. 2014; 126(3-4): 101-5.

Demir K, Avci A, Kaya Z, Marakoglu K, Ceylan E, Yilmaz A, et al. Assessment of atrial electromechanical delay and P-wave dispersion in patients with type 2 diabetes mellitus. J Cardiol. 2016; 67(4): 378-83.

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How to Cite
Rexhepi, A., Asani, V., Ismaili, H., Demiri, F., Ibrahimi , V. ., & Jani , Y. (2022). Assessment of Echocardiography-Derived Total Atrial Activation Time at Patients with Type 2 Diabetes Mellitus. European Journal of Medical and Health Sciences, 4(3), 23–26. https://doi.org/10.24018/ejmed.2022.4.3.1319