Methods: 30 ACR+ T2D patients and 50 ACR- T2D patients were recruited. Patients with prior treatment with insulin or RAAS inhibition were excluded. Cardiac volumes and function were assessed via CMR imaging (3.0T) cine images short axis stack (Figure 1) (10mm LV slices & 5mm LA slices). Following baseline investigations, ACR+ patients were optimised on RAAS inhibition and testing repeated after 1-year.
Results: ACR + group exhibited significantly worse LA function compared to ACR- group (Table 1). 1-year treatment with RAAS inhibition in the ACR+ group led to significant improvements in LA and LV function, despite no significant changes in 24-hour systolic or diastolic BP (Table 1).
Conclusions: Asymptomatic ACR+ T2D patients exhibit reduced LA function compared to ACR- T2D patients. RAAS inhibition improved LA function, despite no significant change in BP. Supporting mechanisms are likely to include the direct beneficial influence of RAAS inhibition on LA myocardium and given established links between LA function and LV haemodynamics, a decreased LA afterload with reduced LV filling pressures.