Key result
In asymptomatic patients with type 2 diabetes and early chronic kidney disease, impaired left atrial reservoir strain (LASr <18.5%) was associated with a nearly fourfold increased risk of major adverse cardiovascular events (HR 3.95).
Why the study?
The study aimed to use 4D Auto LAQ to evaluate left atrial morphological and functional changes in asymptomatic T2DM patients with early CKD and explore their correlation with MACE.
Does left atrial remodeling assessed by 4D Auto LAQ predict major adverse cardiovascular events in asymptomatic type 2 diabetes patients with early chronic kidney disease?
Cohort (n=361)
No
Does left atrial remodeling assessed by 4D Auto LAQ predict major adverse cardiovascular events in asymptomatic type 2 diabetes patients with early chronic kidney disease?
Hazard Ratio: 3.95 (95% CI 1.76–8.86)
p-value: p=<0.001
In asymptomatic patients with type 2 diabetes and early chronic kidney disease, impaired left atrial reservoir function and increased minimum volume index assessed by 4D echocardiography are strong independent predictors of major adverse cardiovascular events.
May support LASr for risk stratification in asymptomatic T2DM with early CKD; leaves open whether it guides interventions to reduce MACE.
Background: This study aimed to use four-dimensional automatic left atrial quantification (4D Auto LAQ) to quantitatively evaluate the morphological and functional changes in the left atrium (LA) in asymptomatic type 2 diabetes mellitus (T2DM) patients with early chronic kidney disease (CKD), and explore its correlation with major adverse cardiovascular event (MACE) occurrence. Methods: This study enrolled patients with asymptomatic T2DM complicated with early CKD. Then, 4D-Auto LAQ was used to evaluate LA volume index (minimum, maximum, pre-ejection) and LA longitudinal and circumferential strains during each of the three LA phases: reservoir, conduit, and contraction. The primary endpoint for follow-up was defined as the first occurrence of nonfatal acute myocardial infarction, stroke, congestive heart failure, or cardiac death. Univariate and multivariate Cox proportional hazard analyses were used to evaluate the correlation between LA parameters and the MACEs in T2DM patients with early CKD. Results: A total of 361 patients were analyzed (mean age, 59.51 ± 11.17 years). During a median follow-up period of 47 months (interquartile range, 17–59 months), MACEs occurred in 70 patients. After adjusting for various clinical and echocardiographic predictors, increased LA volume and impaired reservoir function (ResF) were each independently associated with the primary endpoint: Left atrium minimum volume index (LAVImin) had an adjusted hazard ratio (HR) of 1.21 (95% confidence interval (CI), 1.08–1.35; p = 0.010), whereas left atrium longitudinal strain during the reservoir phase (LASr) had an adjusted HR of 0.81 (95% CI, 0.74–0.89; p < 0.001). Univariate and multivariate Cox regression analyses indicated that the cumulative incidence of MACEs was significantly greater in patients with LAVImin >16.9 mL/m2 than in those with LAVImin ≤16.9 mL/m2 (HR, 2.25; 95% CI, 1.03–6.39; p = 0.005). Furthermore, patients with a LASr <18.5% faced a markedly elevated risk of MACEs—nearly fourfold greater than individuals with a LASr ≥18.5% (HR, 3.95; 95% CI, 1.76–8.86; p < 0.001). Conclusions: An enlarged left atrium (LAVImin) and impaired ResF (LASr) are strongly associated with long-term outcomes in T2DM patients complicated with early CKD. LASr showed the strongest associations with the occurrence of MACEs.
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Gong et al. (2025) conducted a cohort in Asymptomatic type 2 diabetes mellitus with early chronic kidney disease (n=361). Impaired left atrial reservoir strain (LASr <18.5%) vs. LASr ≥18.5% was evaluated on Major adverse cardiovascular events (MACE: nonfatal acute myocardial infarction, stroke, congestive heart failure, or cardiac death) (HR 3.95, 95% CI 1.76-8.86, p=<0.001). In asymptomatic patients with type 2 diabetes and early chronic kidney disease, impaired left atrial reservoir strain (LASr <18.5%) was associated with a nearly fourfold increased risk of major adverse cardiovascular events (HR 3.95).
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