Presence of type 2 diabetes mellitus in hypertensive patients reduced left atrial reservoir strain by 11.96% and increased left atrioventricular coupling index to 24% versus 22% in hypertension alone, indicating worsened myocardial deformation and atrioventricular uncoupling.
Observational (n=172)
No
Does comorbid type 2 diabetes mellitus worsen left atrioventricular coupling and myocardial deformation in patients with hypertension?
Comorbid type 2 diabetes in hypertensive patients is associated with significantly worse subclinical left atrioventricular uncoupling and myocardial deformation compared to hypertension alone, highlighting the need for integrated cardiometabolic management.
Effect estimate: Difference in LACI: +2% vs hypertension-only; multivariable regression β = 8.10 for HTN-T2DM vs controls and β = 5.52 for HTN-only vs controls (both P < 0.001); ϵs reduced by β = -11.96 vs controls in HTN-T2DM and β= -5.67 in HTN-only; GLS reduced by β= -3.65 for HTN-T2DM and -2.27 for HTN-only; all P < 0.05 or better
Absolute Event Rate: 24% vs 22%
p-value: p=<0.001
Background Hypertension (HTN) and type 2 diabetes mellitus (T2DM) frequently coexist, synergistically increasing heart failure risk. The specific incremental impairment of T2DM on left atrioventricular mechanics in hypertensive patients remains poorly characterised. This study aimed to assess whether the presence of T2DM is associated with further alterations in cardiac deformation and atrioventricular coupling beyond hypertension alone. Methods We performed a retrospective analysis including 130 hypertensive patients (74 HTN-only, 56 HTN-T2DM) and 42 age- and sex-matched controls, all undergoing 3.0 T cardiac magnetic resonance. Intergroup comparisons of atrioventricular function and deformation were adjusted for age, sex, BMI, heart rate and SBP using ANCOVA. Multivariable regression was applied to identify independent determinants of left atrioventricular deformation and coupling, and the independent effect of T2DM. Results Key cardiac parameters demonstrated graded impairment from controls to HTN-only and HTN-T2DM groups (all P 0.05). This progressive decline was evident in LV systolic function peak global longitudinal strain: −19.99% (−21.16, −19.13) vs. −17.15% (−19.18, −15.58) vs. −16.03% (−17.86, −13.94) and LA phasic function reservoir strain/εs: 48 ± 10% vs. 40 ± 14% vs. 33 ± 15%; conduit strain/εe: 33% (27, 36) vs. 21% (16, 31) vs. 16% (10, 24). Consequently, the left atrioventricular coupling index (LACI) was significantly elevated in the HTN-T2DM group 24% (23, 30) compared to both the HTN-only 22% (18, 28) and control groups 17% (16, 20). Multivariable linear regression analysis indicated that in the overall population, hypertensive patients with and without T2DM independently reduced left atrial εs, εe and left ventricular GLS, and significantly increased LACI; the detrimental effects were more marked in the HTN-T2DM group (all P 0.05). In the hypertensive subgroup, after adjusting for confounding factors, comorbid T2DM remained an independent risk factor for reduced LA reservoir function (εs: β = −6.09, P = 0.018), impaired LA conduit function (εe: β = −5.58, P = 0.002), and worsened LV systolic function (GLS: β = −1.37, P = 0.010). Conclusion Hypertensive patients with T2DM demonstrate more significant impairment of myocardial deformation, and worse left atrioventricular uncoupling compared with those with HTN alone, underscoring the need for integrated cardiometabolic management in this high-risk population.
Li et al. (Thu,) conducted a observational in Hypertensive adults with preserved ejection fraction, stratified by presence or absence of type 2 diabetes mellitus (n=172). Presence of type 2 diabetes mellitus (T2DM) vs. Hypertension without type 2 diabetes mellitus was evaluated on Left atrioventricular coupling index (LACI), left atrial reservoir strain (ϵs), left atrial conduit strain (ϵe), and left ventricular global longitudinal strain (GLS) assessed by 3.0 Tesla cardiac magnetic resonance imaging (Difference in LACI: +2% vs hypertension-only; multivariable regression β = 8.10 for HTN-T2DM vs controls and β = 5.52 for HTN-only vs controls (both P < 0.001); ϵs reduced by β = -11.96 vs controls in HTN-T2DM and β= -5.67 in HTN-only; GLS reduced by β= -3.65 for HTN-T2DM and -2.27 for HTN-only; all P < 0.05 or better, p=<0.001). Presence of type 2 diabetes mellitus in hypertensive patients reduced left atrial reservoir strain by 11.96% and increased left atrioventricular coupling index to 24% versus 22% in hypertension alone, indicating worsened myocardial deformation and atrioventricular uncoupling.