Assessment of left atrial volume and functions in prediabetics by using 3 dimensional echocardiography and the relationship between levels of Nt-proANP

Introduction and Objective:Diabetes Mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia resulted from defects in secretion and effects of insulin or from combination of both. If blood sugar level is higher than normal but not high enough to diagnose the patient as diabetes in this case it is defined as prediabetic. Prediabetes is a candidative status to type 2 DM. In prediabetic individuals, the risk of cardiovascular disease is 1.5 times greater than the induviduals with normal blood glucose levels.Left atrial (LA) volume changes have prognostic importance. LA volume and mechanical functions are affected foremost by left ventricular systolic and diastolic functions, conditions such as cardiomyopathy, hypertension, valvular disease, and arrhythmias and also ultimately to be associated with major adverse cardiac events such as atrial fibrillation, heart failure, stroke and death. LA volume and mechanical functions are known to be a important predictor of morbidity and mortality. Assessing volumes and functions of LA by using 3-dimensional echocardiography (3D ECHO) came to the fore in clinical use because it provides accurate measurements.Atrial Natriuretic Peptide (ANP) is a peptide hormone having strong natriuretic, diuretic, and vasoactive properties synthesized in the muscle cells of the heart atrium secreted to the plasma. ANP system is activated in cases where an increase in atrial diameter provided. Increase in the concentration of ANP is proportional to the degree of atrial distension. Plasma ANP levels are positively correlated with the level of blood sugar. Plasma ANP levels are showm to be increased in patients with overt diabetes. Because increase in the concentration is proportional to the degree of distension of atrial, ANP is a marker used to evaluate the pressures and volumes of LA.3D echocardiography has been introduced in recent years in parallel with the increase in echocardiographic quality of images. 3D ECHO provides a view of heart from a desired three-dimensional geometric plane which is based on reconstruction of three-dimensional images obtained from the two-dimensional plane. In addition, 3D ECHO allows obtaining the planar cross-sections of the heart that could not be obtained by 2D ECHO. 3D echocardiography which takes part in routine clinical use has a large number of advantages in evaluation and analysis of heart cavities when compared to 2D ECHO. 3D ECHO has its greatest advantage in volumetric imaging.Aim of this study is to evaluate LA volume and the mechanical functions in prediabetic individuals by using 3D ECHO and to investigate the relationship between N-terminal pro-atrial natriuretic peptide (NT-proANP) and these parameters.