Relation between Epicardial Fat Thickness and Left Atrial Mechanics in Type 2 Diabetes Patients: Strain Imaging Study

Background: Type 2 diabetes mellitus (T2DM) is linked to early myocardial dysfunction, particularly diastolic impairment and atrial remodeling. Epicardial adipose tissue may contribute to subclinical cardiac dysfunction through mechanical and inflammatory effects. This study evaluated the relationship between epicardial fat thickness (EFT) and left atrial (LA) strain measured by speckle-tracking echocardiography in patients with T2DM compared with non-diabetic controls. Methods: This case–control study at Menoufia University Hospitals included 78 participants equally divided into two groups: 39 healthy controls and 39 patients with T2DM diagnosed according to the American Diabetes Association criteria. Participants underwent clinical evaluation, laboratory investigations, conventional echocardiography, Doppler assessment, and speckle-tracking echocardiography to measure LA reservoir (LASr), conduit (LAScd), and contractile (LASct) strain. EFT was measured from the parasternal long-axis view. Results: Patients with T2DM had higher body mass index, waist circumference, fasting glucose, glycosylated hemoglobin, and lipid levels than controls ( P < 0.05). Left ventricular ejection fraction was similar between groups. However, diastolic parameters were impaired in the diabetic group, with lower E/A ratio and e′ velocities and higher E/e′ ratio ( P < 0.001). EFT was greater in T2DM patients ( P < 0.001). LASr, LAScd, and LASct strain values were reduced ( P < 0.001). EFT correlated negatively with LASr ( r = −0.341, P = 0.034) and LAScd ( r = −0.322, P = 0.046). Conclusion: Increased EFT in T2DM is associated with impaired LA strain, suggesting early atrial dysfunction before structural remodeling.