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Modulation of renin-angiotensin-aldosterone system reverses adverse left atrial remodelling in type 2 diabetes

Session Poster session 1

Speaker Thomas Craven

Congress : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Systolic and Diastolic Function
  • Session type : Poster Session
  • FP Number : P153

Authors : T Craven (Leeds,GB), E Levelt (Leeds,GB), N Jex (Leeds,GB), M Jain (Leeds,GB), LAE Brown (Leeds,GB), CED Saunderson (Leeds,GB), A Das (Leeds,GB), E Dall' Armellina (Leeds,GB), P Bijsterveld (Leeds,GB), JP Greenwood (Leeds,GB), S Plein (Leeds,GB), PP Swoboda (Leeds,GB)

Authors:
T Craven1 , E Levelt1 , N Jex2 , M Jain1 , LAE Brown1 , CED Saunderson1 , A Das1 , E Dall' Armellina1 , P Bijsterveld1 , JP Greenwood1 , S Plein1 , PP Swoboda1 , 1University of Leeds - Leeds - United Kingdom of Great Britain & Northern Ireland , 2Leeds Teaching Hospitals NHS Trust - Leeds - United Kingdom of Great Britain & Northern Ireland ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii104

Background: Heart failure is a major cause of morbidity and mortality in type 2 diabetes (T2D). Renin-angiotensin-aldosterone system (RAAS) is a crucial driver of the myocardial structural and functional changes in diabetes.  Left atrial (LA) function recently emerged as an important prognostic factor, thus we aimed to investigate the effect of RAAS inhibition on LA remodelling in T2D patients with microalbuminuria (ACR+). 

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.

ACR -(n=50)

ACR + Baseline (n=30)

P value

ACR + Year 1 (n=30)

P value

Age

62 ± 9 years

63 ± 12 years

NS

Diabetes median duration, years

3 [1.6-6.0]

5 [1.3-6.8]

NS

Mean 24-h BP, mmHg

130 ± 13/

71 ±9

135 ± 19 /

73 ±11

NS

132 ± 20 / 71 ± 11

NS

HbA1c, mmol/L

60 ± 14

61 ± 20

NS

62 ± 16

NS

LV end-diastolic volume, ml

149.2±32.4

147.2±36.3

NS

139 ± 37

0.0001

LV end-systolic volume, ml

58 ±16

60 ± 24

NS

55 ± 25

0.0035

LV ejection fraction, %

62 ± 5

59 ± 8

0.038

62 ±9

0.038

LA end systolic volume, ml

89 ± 18

90 ± 30

NS

89 ± 26

NS

LA end diastolic volume, ml

44 ± 11

50 ± 20

0.0387

46 ±17

0.0387

LA ejection fraction, %

51 ± 5

45 ± 6

<0.0001

49 ± 6

<0.0001

Table 1: Clinical and imaging parameter differences between ACR- and ACR+ Type 2 Diabetic patients at baseline and ACR+ patients after 1 year of renin-angiotensin-aldosterone system inhibition. ACR, albumin:creatinine ratio; BP, blood pressure; HbA1c, hemoglobin A1c; LA, left atrial; LV, left ventricular; NS, non-significant.


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