November 22, 2019Open Access

Difference in left atrial appendage remodeling between diabetic and nondiabetic patients with atrial fibrillation

Structured PICO

Does diabetes mellitus alter left atrial appendage remodeling and flow velocity in patients with persistent atrial fibrillation?

Population

n=242 adults with persistent atrial fibrillation (>18 months) undergoing transesophageal echocardiography for AFib ablation, cardioversion, or LAA device closure, divided into diabetic (n=122) and nondiabetic (n=120) groups. Mean age ~65, ~39% female, based in Israel. Key exclusion: ≤18 years old, significant valvular disease, mechanical or infected valves.

Intervention

Diabetes mellitus (observational exposure)

Comparator

No diabetes mellitus

Outcome

Left atrial appendage (LAA) dimensions (length, width, depth, area) and orifice flow velocity measured by real-time 3-dimensional transesophageal echocardiography (RT3DTEE)surrogate

Diabetes mellitus in patients with persistent atrial fibrillation is associated with adverse left atrial appendage remodeling, characterized by orifice enlargement and reduced flow velocity, potentially increasing thrombotic risk.

Abstract

Abstract Background Diabetes mellitus (DM) is a common and increasingly prevalent condition in patients with atrial fibrillation (AFib). The left atrium appendage (LAA), a small outpouch from the LA, is the most common location for thrombus formation in patients with AFib. Hypothesis In this study, we examined LAA remodeling differences between diabetic and nondiabetic patients with AFib. Methods This retrospective study analyzed data from 242 subjects subdivided into two subgroups of 122 with DM (diabetic group) and 120 without DM (nondiabetic group). The study group underwent real‐time 3‐dimensional transesophageal echocardiography (RT3DTEE) for AFib ablation, cardioversion, or LAA device closure. The LAA dimensions were measured using the “Yosefy rotational 3DTEE method.” Results The RT3DTEE analysis revealed that diabetic patients display larger LAA diameters, D1‐lengh (2.09 ± 0.50 vs 1.88 ± 0.54 cm, P = .003), D2‐width (1.70 ± 0.48 vs 1.55 ± 0.55 cm, P = .024), D3‐depth (2.21 ± 0.75 vs 1.99 ± 0.65 cm, P = .017), larger orifice areas (2.8 ± 1.35 and 2.3 ± 1.49 cm 2 , P = .004), and diminished orifice flow velocity (37.3 ± 17.6 and 43.7 ± 19.5 cm/sec, P = .008). Conclusions Adverse LAA remodeling in DM patients with AFib is characterized by significantly LAA orifice enlargement and reduced orifice flow velocity. Analysis of LAA geometry and hemodynamics may have clinical implications in thrombotic risk assessment and treatment of DM patients with AFib.

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