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Diagnosis of nonischemic stage B heartáfailure in type 2 diabetes mellitus: optimal parameters for prediction of heart failure


Wang, Y and Yang, H and Huynh, Q and Nolan, M and Negishi, K and Marwick, TH, Diagnosis of nonischemic stage B heart failure in type 2 diabetes mellitus: optimal parameters for prediction of heart failure, JACC: Cardiovascular Imaging, 11, (10) pp. 1390-1400. ISSN 1936-878X (2018) [Refereed Article]

Copyright Statement

ę 2018 by the American College of Cardiology Foundation.

DOI: doi:10.1016/j.jcmg.2018.03.015


Objectives: This study sought to identify whether impaired global longitudinal strain (GLS), diastolic dysfunction (DD), or left atrial enlargement (LAE) should be added to stage B heart failure (SBHF) criteria in asymptomatic patients with type 2 diabetes mellitus.

Background: SBHF is a precursor to clinical heart failure (HF), and its recognition justifies initiation of cardioprotective therapy. However, original definitions of SBHF were based on LV hypertrophy and impaired ejection fraction.

Methods: Patients with asymptomatic type 2 diabetes mellitusá≥65 years-of-age (age 71 ▒ 4 years; 55% men) with preserved ejection fraction and no ischemic heart disease were recruited from a community-based population. All underwent a standard clinical evaluation, and a comprehensive echocardiogram, including assessment of left ventricular hypertrophy (LVH), LAE, DD (abnormal E/e'), and GLS (<16%). Over a median follow-up of 1.5 years (range 0.5 to 3), 20 patients were lost to follow-up, and 290 individuals were entered into the final analyses.

Results: In this asymptomatic group, LV dysfunction was identified in 30 (10%) by DD, 68 (23%) by LVH, 102 (35%) by LAE, and 68 (23%) by impaired GLS. New-onset HF developed in 45 patients and 4 died, giving an event rate of 112/1,000 person-years. Survival free of the composite endpoint (HF and death) was about 1.5-fold higher in patients without a normal, compared with an abnormal echocardiogram. LVH, LAE, and GLSá<16% were associated with increased risk of the composite endpoint, independent of ARIC risk score and glycosylated hemoglobin, but abnormal E/e' was not. The addition of left atrial volume and GLS provided incremental value to the current standard of clinical risk (ARIC score) and LVH. In a competing-risks regression analysis, LVH (hazard ratio: 2.90; pá< 0.001) and GLSá<16% (hazard ratio: 2.26; pá= 0.008), but not DD and LAE were associated with incident HF.

Conclusions: Subclinical left ventricular systolic dysfunction is prevalent in asymptomatic elderly patients with type 2 diabetes mellitus, and impaired GLS is independent and incremental to LVH in the prediction of incident HF.

Item Details

Item Type:Refereed Article
Keywords:T2DM, community, echocardiography, global longitudinal strain, stage B heart failure, subclinical LV dysfunction
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Wang, Y (Ms Ying Wang)
UTAS Author:Yang, H (Ms Hilda Yang)
UTAS Author:Huynh, Q (Dr Quan Huynh)
UTAS Author:Nolan, M (Mr Mark Nolan)
UTAS Author:Negishi, K (Dr Kazuaki Negishi)
UTAS Author:Marwick, TH (Professor Tom Marwick)
ID Code:128057
Year Published:2018
Web of Science® Times Cited:39
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-08-30
Last Modified:2022-08-30

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