Assessment of Left Atrial Phasic Functions in Type 2 Diabetes Mellitus patients Associated with Non-Alcoholic Fatty Liver Disease by 2D Speckle Tracking Echocardiography

Left atrium (LA) plays an important role in maintaining optimal cardiac output. Diabetes mellitus has been considered independent cardiovascular risk factors that can affect all cardiac chambers including the left atrium. Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common chronic liver disease in T2DM and is considered as a risk factor for early subclinical cardiac abnormalities including left atrium. Assessment of LA phasic functions in type 2 Diabetes Mellitus patients associated with NAFLD using 2D Speckle tracking echocardiography. Sixty patients with type 2 DM  associated with NAFLD and 30 healthy control subjects were included and subjected to full clinical assessment, full laboratory evaluation, abdominal ultrasound, and echo-Doppler examination measurements included LV dimensions, ejection fraction, trans-mitral Doppler flow and tissue Doppler velocities (E, A, E/A, E/Em), LA dimensions, volumes, phasic LA peak strain (2D-Peak LAS). Group I had higher values LA superior inferior dimension, mitral valve late diastolic velocity (A) and mitral valve early diastolic velocity to average early diastolic velocity of MV annulus by TDI (E/Em ratio) compared to the control group. On the other hand, they had lower values parameters of reservoir & contractile function (Peak atrial strain during ventricular systole & Late peak strain just before the active atrial contractile phase, compared to the control subjects. While LA conduit function tends to be reduced but did not reach statistically significant. HgA1c significantly had negative correlation with LA reservoir and contractile function (r= -0.30, p<0.01). Type 2 DM with NAFLD is associated with subclinical impairment of LA phasic functions using 2D speckle tracking   echocardiography. Subclinical LA phasic functions are affected by patient’s glycemic control. Moreover, the presence of NAFLD in diabetic patients double the risk of subclinical cardiovascular affection.