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European Journal of Heart Failure 2008 10(11):1080-1087; doi:10.1016/j.ejheart.2008.08.012
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© 2008 European Society of Cardiology

Left atrial velocity vector imaging for the detection and quantification of left ventricular diastolic function in type 2 diabetes

Christina Jarnerta,*, Anders Melcherb, Kenneth Caidahlb, Hans Perssonc, Lars Rydéna and Maria J. Erikssonb

a Cardiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet Stockholm, Sweden
b Clinical Physiology Unit, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet Stockholm, Sweden
c Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet Stockholm, Sweden

* Corresponding author. Department of Cardiology, Karolinska University Hospital, 171 76 Stockholm, Sweden. Tel.: +46 8 517 700 00. E-mail address: christina.jarnert{at}karolinska.se (C. Jarnert)


  Abstract

Left ventricular (LV) diastolic dysfunction (DD) is diagnosed by Doppler echocardiography (DE) and Tissue Doppler imaging (TDI). Velocity vector imaging (VVI) evaluates myocardial deformation (strain). We studied left atrial (LA) deformation and volumes by VVI in relation to established Doppler-derived indices of LV diastolic function in diabetic patients.

Material: Using DE and TDI, 87 patients (males 49%; age 60±7 years) with type 2 diabetes mellitus were classified as having no (n=60), mild (n=13) or moderate (n=14) DD.

Results: LA volume was larger in moderate (72.3±22.4 ml) than in mild DD (58.8±16.1 ml; p=0.01) and no DD (57.9±16.0 ml; p=0.01). LA roof strain distinguished no DD from mild and moderate DD (p=0.0073). Systolic LA strain correlated to total emptying fraction (r=0.70, p<0.0001), and inversely to LA volume (r=–0.35, p=0.0009). A cross-validated analysis of no versus mild or moderate DD expressed by LA strain revealed a positive predictive value of 48% and negative of 84%.

Conclusion: LA strain by VVI is impaired in patients with type 2 diabetes mellitus and mild or moderate LV DD. LA strain seems of value in distinguishing normal from abnormal diastolic function. VVI offers new information on regional LA function and LA volumes but has too limited discriminative power to detect early LV DD.

Key Words: Diastolic dysfunction • Left atrium • Velocity vector imaging • Diabetes mellitus • Echocardiography • Doppler tissue imaging

Received April 8, 2008; Revised June 25, 2008; Accepted August 28, 2008


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