Effect of glycemic status on the natural history of left atrial structure and function in adults with metabolic syndrome and obesity.

BACKGROUND

Information on the natural history of left atrial (LA) echocardiographic parameters in patients with metabolic syndrome (MS) and obesity is limited. We investigated the association between glycemic status and markers of LA structure and function.

METHODS

Longitudinal, prospective, multicenter study in patients with MS and a body mass index ≥27 and < 40 kg/m2, without cardiovascular disease. A central echocardiography laboratory evaluated LA echocardiographic parameters at baseline and at 3 and 5 years of follow-up. At baseline, glycemic status was categorized as normoglycemia, prediabetes, or diabetes according to established criteria. The association between glycemic status and LA structure and function was estimated using multiple regression models adjusted for potential confounders.

RESULTS

We analyzed 553 participants (mean age 65 ± 5 years; 40% women) with normoglycemia (n = 68), prediabetes (n = 287), or diabetes (n = 198). Compared with baseline, at 5 years the LA volume index increased (22.9 ± 7 to 27.1 ± 8.9, p < 0.0001), LA reservoir strain decreased (27.8 ± 6.5 to 23.3 ± 6.6, p < 0.0001), LA stiffness index increased (0.35 ± 0.17 to 0.41 ± 0.26, p < 0.0001), LA function index decreased (67.3 ± 29.2 to 55.8 ± 24.3, p < 0.0001), and the left atrioventricular coupling index increased (21.7 ± 10.5 to 32.2 ± 20.3, p < 0.0001). No association was found between glycemic status and LA echocardiographic parameters of atrial function.

CONCLUSIONS

In a population with MS and obesity but free of cardiovascular disease, glycemic status was not strongly associated with longitudinal changes in echocardiographic markers of LA structure or function. In all three groups, echocardiographic parameters worsened significantly during follow-up.