Left Atrial Remodeling Predicts Cardiovascular Risk in Asymptomatic Diabetes Patients with Early CKD: Study

Led by Dr. Mingxia Gong and researchers from the Department of Echocardiography at The Third Affiliated Hospital of Soochow University, the study utilized advanced imaging techniques to assess whether changes in the left atrium (LA) could predict future cardiovascular events in this high-risk yet often overlooked population.

"In asymptomatic type 2 diabetes patients, progression of diabetic nephropathy was associated with higher LAVImin and lower LASr, both reflecting declining kidney function. These markers independently predicted major cardiovascular events (AUC: 0.818), emphasizing the value of LA strain analysis in early cardiorenal risk evaluation," the researchers reported.

Using four-dimensional automatic left atrial quantification (4D Auto LAQ), the team evaluated 361 individuals with asymptomatic T2DM and early CKD. The imaging measured LA volume indices, such as minimum (LAVImin), maximum, and pre-ejection volumes, and strain values reflecting LA function during reservoir, conduit, and contraction phases.

Over a median follow-up of nearly four years, 70 participants experienced major adverse cardiovascular events (MACEs), which included nonfatal myocardial infarction, stroke, heart failure, or cardiac death. Through detailed statistical analyses, including Cox proportional hazard models, the study identified two LA parameters as independent predictors of cardiovascular risk: increased LAVImin and reduced longitudinal strain during the reservoir phase (LASr).

The key findings of the study include the following:

• Each unit increase in LAVImin was associated with a 21% higher risk of major adverse cardiovascular events (adjusted HR: 1.21).
• Higher LASr values were linked to a significantly lower risk of cardiovascular events (adjusted HR: 0.81).
• Patients with LAVImin >16.9 mL/m² had more than twice the risk of MACEs compared to those with LAVImin ≤16.9 mL/m².
• Individuals with LASr <18.5% faced nearly a fourfold increased risk of MACEs compared to those with LASr ≥18.5%.
• LASr was identified as the strongest echocardiographic predictor of cardiovascular events among the parameters studied.
• The predictive accuracy of LAVImin and LASr for MACEs was high, with an AUC of 0.818.

The researchers emphasize that these structural and functional changes in the left atrium may reflect early cardiovascular stress due to underlying diabetic nephropathy, even in the absence of symptoms. As such, integrating 4D LA quantification—especially LASr—into routine cardiac evaluations could enhance early detection and risk stratification in T2DM patients with renal involvement.

"While further studies with larger populations are warranted, the results emphasize the clinical utility of LA remodeling parameters in guiding early intervention strategies aimed at reducing cardiovascular complications in diabetic patients with early kidney dysfunction," the authors concluded.

Reference:

Mingxia Gong, Min Xu, Suoya Pan, Shu Jiang, Xiaohong Jiang. Association of Left Atrium Remodeling With Major Adverse Cardiovascular Events in Asymptomatic Type 2 Diabetes Patients With Early Chronic Kidney Disease. Rev. Cardiovasc. Med. 2025, 26(5), 27247. https://doi.org/10.31083/RCM27247