1University of Bergen, Institute of Medicine, Bergen, Norway2Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
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Purpose: The purpose of this study was to assess the prevalence of left atrial enlargement and its association with left ventricular (LV) diastolic dysfunction among Tanzanian diabetic patients of African origin.Methods: Cardiovascular risk assessment and echocardiography was performed in 184 diabetic out-patients attending Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients were categorized into groups of normal LV diastolic function (n = 73), impaired relaxation (n = 51), pseudonormal (n = 58) and restrictive LV filling (n = 2) patterns based on their mitral inflow and tissue Doppler indices. Left atrial volume was measured using biplane Simpson's method and indexed to body surface area (LAVI). Results: The study population included 61 type 1 and 123 type 2 diabetic patients, mean age 44±19 years, 61% females. LAVI increased progressively with increasing LV diastolic dysfunction (Table 1), and was more often increased (>28ml/m2) in type 2 diabetic patients (48% vs 31%), respectively, p<0.05). In univariate analysis, larger LAVI was associated with older age, longer duration of diabetes, higher body mass index, blood pressure, LV mass index and E/E', presence of mitral regurgitation as well as lower ejection fraction and eGFR (all p<0.05). In multivariate linear regression analysis (multiple R2 = 0.37, p<0.001) including the four groups of diastolic function as dummy variables, LAVI was associated with the severity of LV diastolic dysfunction independent of significant associations with LV hypertrophy (ß = 0.29, p < 0.001) and presence of mitral regurgitation (ß = 0.25, p < 0.001).Conclusion: LAVI is a marker of severity of LV diastolic dysfunction in diabetic patients of sub-Saharan African origin independent of LV hypertrophy and presence of mitral regurgitation.