Atrial fibrillation (AF) has been linked to an increased risk of cardiovascular death, overall mortality and heart failure in patients with type 2 diabetes mellitus (T2DM). The present study investigated the additive effects of paroxysmal AF on left ventricular (LV) function and deformation in T2DM patients with or without AF using the cardiovascular magnetic resonance feature tracking (CMR-FT) technique. The present study encompassed 225 T2DM patients differentiated by the presence or absence of paroxysmal AF [T2DM(AF+) and T2DM(AF−), respectively], along with 75 age and sex matched controls, all of whom underwent CMR examination. LV function and global strains, including radial, circumferential and longitudinal peak strain (PS), as well as peak systolic and diastolic strain rates (PSSR and PDSR, respectively), were measured and compared among the groups. Multivariable linear regression analysis was used to examine the factors associated with LV global strains in patients with T2DM. The T2DM(AF+) group was the oldest, had the highest LV end‑systolic volume index, lowest LV ejection fraction and estimated glomerular filtration rate compared to the control and T2DM(AF−) groups, and presented a shorter diabetes duration and lower HbA1c than the T2DM(AF−) group. LV PS-radial, PS-longitudinal and PDSR-radial declined successively from controls through the T2DM(AF−) group to the T2DM(AF+) group (all p < 0.001). Compared to the control group, LV PS-circumferential, PSSR-radial and PDSR-circumferential were decreased in the T2DM(AF+) group (all p < 0.001) but preserved in the T2DM(AF−) group. Among all clinical indices, AF was independently associated with worsening LV PS-longitudinal (β = 2.218, p < 0.001), PS-circumferential (β = 3.948, p < 0.001), PS-radial (β = − 8.40, p < 0.001), PSSR-radial and -circumferential (β = − 0.345 and 0.101, p = 0.002 and 0.014, respectively), PDSR-radial and -circumferential (β = 0.359 and − 0.14, p = 0.022 and 0.003, respectively). In patients with T2DM, the presence of paroxysmal AF further exacerbates LV function and deformation. Proactive prevention, regular detection and early intervention of AF could potentially benefit T2DM patients.

中文翻译：

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阵发性房颤对2型糖尿病患者左心室功能和变形的恶化影响：3.0T心血管磁共振特征跟踪研究

心房颤动 (AF) 与 2 型糖尿病 (T2DM) 患者心血管死亡、总体死亡率和心力衰竭风险增加有关。本研究利用心血管磁共振特征跟踪 (CMR-FT) 技术，研究了阵发性 AF 对伴或不伴 AF 的 T2DM 患者左心室 (LV) 功能和变形的附加影响。本研究包括 225 名通过是否存在阵发性 AF 来区分的 T2DM 患者[分别为 T2DM(AF+) 和 T2DM(AF−)]，以及 75 名年龄和性别匹配的对照者，所有患者均接受了 CMR 检查。测量并比较各组之间的左心室功能和整体应变，包括径向、周向和纵向峰值应变（PS），以及收缩期和舒张期峰值应变率（分别为 PSSR 和 PDSR）。采用多变量线性回归分析来检查与 T2DM 患者左心室整体应变相关的因素。与对照组和 T2DM(AF−) 组相比，T2DM(AF+) 组年龄最大，左室收缩末期容积指数最高，左室射血分数和估计肾小球滤过率最低，糖尿病病程较短，糖化血红蛋白 (HbA1c) 较低高于 T2DM(AF−) 组。LV PS 径向、PS 纵向和 PDSR 径向从对照组到 T2DM(AF−) 组至 T2DM(AF+) 组依次下降（所有 p < 0.001）。与对照组相比，T2DM(AF+) 组的 LV PS 周向、PSSR 径向和 PDSR 周向降低（均 p < 0.001），但 T2DM(AF−) 组保持不变。在所有临床指标中，房颤与左室恶化 PS-纵向（β = 2.218，p < 0.001）、PS-周向（β = 3.948，p < 0.001）、PS-径向（β = − 8.40，p < 0.001）独立相关）、PSSR-径向和-圆周（β = − 0.345 和 0.101，分别为 p = 0.002 和 0.014）、PDSR-径向和 -圆周（β = 0.359 和 − 0.14，分别为 p = 0.022 和 0.003）。在 T2DM 患者中，阵发性 AF 的存在进一步加剧了左室功能和变形。主动预防、定期检测和早期干预 AF 可能会使 T2DM 患者受益。