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Association Between Diabetes Mellitus and Left Atrial Strain in Individuals With Hypertension

Camila Mota Guida1, Jonathan Batista Souza1, Fernando Yue Cesena1

  • 1Dante Pazzanese Institute of Cardiology, Division of Cardiology, São Paulo, Brazil.

Echocardiography (Mount Kisco, N.Y.)
|June 17, 2025
PubMed

Insights

Diabetes significantly reduces left atrial (LA) reservoir and conduit strain in hypertensive patients. Speckle-tracking echocardiography can detect this early atrial dysfunction, aiding cardiovascular risk assessment.

Area of Science:

  • Cardiology
  • Diabetology
  • Echocardiography

Background:

  • Atrial remodeling is common in patients with diabetes and hypertension, increasing cardiovascular event risk.
  • Early detection of atrial dysfunction is crucial for managing cardiovascular complications.
  • Left atrial (LA) strain assessed by speckle-tracking echocardiography shows promise but requires further investigation in diabetic hypertensive populations.

Purpose of the Study:

  • To investigate the impact of diabetes on left atrial (LA) strain parameters in patients with hypertension.
  • To evaluate the association between diabetes and LA reservoir (S-LAr), LA conduit (S-LAc), and LA contractile (S-LAct) strains.
  • To explore the mediating role of diastolic dysfunction and left ventricular (LV) strain in the relationship between diabetes and LA strain.

Main Methods:

  • Sixty-four hypertensive individuals were categorized into two groups: with diabetes (DM(+)) and without diabetes (DM(-)).
  • Transthoracic echocardiography was performed to assess clinical and echocardiographic characteristics, including LA strain parameters (S-LAr, S-LAc, S-LAct).
  • Multivariable regression and mediation analyses were used to evaluate the association between diabetes and LA strain, adjusting for confounding factors.

Main Results:

  • No significant differences in standard echocardiographic parameters were observed between DM(+) and DM(-) groups.
  • Patients with diabetes exhibited significantly lower S-LAr (27.8% ± 7.0% vs. 32.1% ± 6.4%, p=0.013) and S-LAc (12.0% ± 4.8% vs. 16.0% ± 5.1%, p=0.002).
  • Diabetes remained independently associated with reduced S-LAr and S-LAc, with the effect primarily direct and not mediated by diastolic dysfunction or LV strain.

Conclusions:

  • Diabetes is associated with impaired left atrial reservoir and conduit function in hypertensive individuals.
  • Speckle-tracking echocardiography is a sensitive tool for detecting early atrial dysfunction in patients with diabetes and hypertension.
  • These findings highlight the detrimental effects of diabetes on atrial mechanics, independent of diastolic dysfunction or LV strain.
Abstract

Keywords:
diabetes mellitusheart failure with preserved ejection fractionhypertensionleft atrial strainspeckle‐tracking echocardiography

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