ORIGINAL ARTICLE Left atrial phasic function and heart rate variability in asymptomatic diabetic patients Marijana Tadic 1 • Vladan Vukomanovic 1 • Cesare Cuspidi 3 • Jelena Suzic-Lazic 1 • Dejana Stanisavljevic 4 • Vera Celic 1,2 Received: 6 November 2016 / Accepted: 30 December 2016 Ó Springer-Verlag Italia 2017 Abstract Aims We evaluated left atrial (LA) phasic function and heart rate variability (HRV) in asymptomatic diabetic patients, and the relationship between HRV indices and LA phasic function assessed by volumes and speckle tracking imaging. Method This cross-sectional study included 55 asymp- tomatic patients with type 2 diabetes and 50 healthy con- trols without cardiovascular risk factors. All study subjects underwent laboratory analyses, complete two-dimensional echocardiography examination (2DE) and 24-h Holter monitoring. Results Maximum, minimum LA and pre-A LA volumes and volume indexes are significantly higher in diabetic patients. Total and passive LA emptying fractions (EF), representing the LA reservoir and conduit function, are significantly lower in diabetic subjects. Active LA EF, the parameter of the LA booster pump function, is compensatory increased in diabetic patients. Similar results were obtained by 2DE strain analysis. Cardiac autonomic function, assessed by HRV, is significantly deteriorated in diabetic patients. Time and frequency-domain HRV mea- sures are significantly lower in diabetic subjects than in controls. HbA1c, LV mass index and HRV are associated with total LA EF and longitudinal LA strain independently of age, body mass index and LV diastolic function in the whole study population. Conclusions LA phasic function and cardiac autonomic nervous system assessed by HRV are impacted by diabetes. HbA1c and HRV are independently associated with LA reservoir function evaluated by volumetric and strain methods in the whole study population. This study empha- sizes the importance of determination of LA function and HRV as important markers of preclinical cardiac damage and autonomic function impairment in diabetic patients. Keywords Diabetes Á Left atrium Á Phasic function Á Heart rate variability Á Strain Introduction Left atrial (LA) phasic function represents the important determinant of left ventricular filling pressure and diastolic function [1–3]. In everyday clinical circumstances, LA was mostly described by the linear measurements, until a few years ago when the large prospective studies showed that the LA volume represents an important predictor of mor- tality in general population [4, 5]. The introduction of the new imaging tool—strain—showed how global and phasic mechanical LA function could be important predictors in patients with heart failure, valvular diseases, atrial fibril- lation and ischemic heart disease [6]. Managed by Antonio Secchi. Marijana Tadic and Vladan Vukomanovic have contributed equally. & Marijana Tadic marijana_tadic@hotmail.com 1 Department of Cardiology, University Clinical Hospital Center ‘‘Dr. Dragisa Misovic - Dedinje’’, Heroja Milana Tepica 1, 11000 Belgrade, Serbia 2 Faculty of Medicine, Doktora Subotica 6, 11000 Belgrade, Serbia 3 Clinical Research Unit, Istituto Auxologico Italiano, University of Milan-Bicocca, Viale della Resistenza 23, 20036 Meda, Italy 4 Institute for Medical Statistics and Informatics, Doktora Subotica 15, 11000 Belgrade, Serbia 123 Acta Diabetol DOI 10.1007/s00592-016-0962-x