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Aims: Patients with heart failure (HF) risk factors are described as being in Stage A of this condition (SAHF). Management is directed towards prevention of HF progression, but to date, no evidence has been described to align the intensity of this intervention to HF risk. We sought to what extent SAHF of Type 2 diabetes mellitus (T2DM) and other HF risks showed differences in subclinical left ventricular function, exercise capacity, and prognosis.

Methods and Results: We recruited 551 elder asymptomatic SAHF patients (age 71 ± 5 years, 49% men, 290 T2DM) with at least one risk factor from a community-based population with preserved ejection fraction. All underwent a comprehensive echocardiogram including global longitudinal strain (GLS) and a 6 min walk test and were followed for 2 years. The primary endpoints were new-onset HF and all-cause mortality. The T2DM group was associated with reduced 6 min walk test distance (451 ± 111 vs. 493 ± 87 m, P < 0.001), worse diastolic function (E/e' 9.2 ± 2.7 vs. 8.7 ± 2.4, P = 0.028), and impaired GLS (-17.7 ± 2.6% vs. -19.0 ± 2.6%, P < 0.001). Over a median follow-up of 1.6 years, 49 T2DM-SAHF and 27 other-SAHF met the primary endpoint. T2DM-SAHF had significantly worse outcome than other-SAHF (P = 0.021). In Cox models, obesity [hazard ratio (HR) = 2.46; P = 0.007], atrial fibrillation (HR = 2.39; P = 0.028), 6 min walk distance (HR = 0.99; P = 0.034), and GLS (HR = 1.14; P = 0.033) were independently associated with the primary endpoint in T2DM-SAHF, independent of age and glycaemic control.

Conclusions: The T2DM-SAHF has worse subclinical left ventricular function, exercise capacity, and prognosis than other-SAHF. Impaired GLS, atrial fibrillation, exercise capacity, and obesity are associated with a worse prognosis in T2DM-SAHF but not in other-SAHF.

Item Type:	Refereed Article
Keywords:	6 min walk, diabetes mellitus, global longitudinal strain, heart failure
Research Division:	Medical and Health Sciences
Research Group:	Cardiorespiratory Medicine and Haematology
Research Field:	Cardiology (incl. Cardiovascular Diseases)
Objective Division:	Health
Objective Group:	Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:	Cardiovascular System and Diseases
Author:	Wang, Y (Ms Ying Wang)
Author:	Yang, H (Ms Hong Yang)
Author:	Nolan, M (Mr Mark Nolan)
Author:	Pathan, F (Dr Faraz Pathan)
Author:	Negishi, K (Dr Kazuaki Negishi)
Author:	Marwick, TH (Professor Tom Marwick)
ID Code:	125466
Year Published:	2018
Deposited By:	Menzies Institute for Medical Research
Deposited On:	2018-04-18
Last Modified:	2018-05-07
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