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Evolution of myocardial dysfunction in asymptomatic patients at risk of heart failure


Halabi, A and Yang, H and Wright, L and Potter, E and Huynh, Q and Negishi, K and Marwick, TH, Evolution of myocardial dysfunction in asymptomatic patients at risk of heart failure, JACC: Cardiovascular Imaging, 14, (2) pp. 350-361. ISSN 1936-878X (2020) [Refereed Article]

Copyright Statement

Copyright 2020 Elsevier

DOI: doi:10.1016/j.jcmg.2020.09.032


Objectives: The determinants of changes in systolic and diastolic parameters in patients aged >65 years, at risk of heart failure (HF), and with and without asymptomatic type 2 diabetes mellitus (T2DM) was assessed by echocardiography. The association between metformin and myocardial function was also assessed.

Background: The increasing prevalence of T2DM will likely further fuel the epidemic of HF. Understanding the development or progression of left ventricular (LV) dysfunction may inform effective measures for HF prevention.

Methods: A total of 982 patients with at least one HF risk factor (hypertension, obesity, or T2DM) were recruited from 2 community-based populations and divided into 2 groups: T2DM (n = 431, age 71 4 years) and non-T2DM (n = 551, age 71 5 years). Associations of metformin therapy were evaluated in the T2DM group. All underwent a comprehensive echocardiogram, including global longitudinal strain (GLS) and diastolic function (transmitral flow [E], annular velocity [e']) at baseline and follow-up (median 19 months [interquartile range: 17-26]). Comparisons were facilitated by propensity matching.

Results: A reduction in GLS was observed in the T2DM group (baseline -17.8 2.6% vs. follow-up -17.4 2.8%; p = 0.003), but not in the non-T2DM group (-18.7 2.7% vs. -18.6 3.0%; p = 0.41). Estimated LV filling pressures increased in both the T2DM group (p = 0.001) and the non-T2DM group (p = 0.04). Metformin-treated patients with T2DM did not increase estimated LV filling pressure (E/e' baseline 8.9 2.7 vs. follow-up 9.1 2.7; p = 0.485) or change e' (7.6 1.5 cm/s vs. 7.6 1.8 cm/s; p = 0.88). After propensity matching, metformin was associated with a smaller change in e' (β = 0.58 [95% CI 0.13 to 1.03]; p = 0.013) and E/e' (β = -0.96 [95% CI -1.66 to -0.26]; p = 0.007) but was not associated with a change in GLS (p = 0.46).

Conclusions: Over 2 years, there is a worsening of GLS and LV filling pressures in asymptomatic diabetic patients with HF risk factors. Metformin use is associated with less deterioration of LV filling pressures and myocardial relaxation but had no association with systolic function.

Item Details

Item Type:Refereed Article
Keywords:diastolic dysfunction, metformin, myocardial strain, type 2 diabetes mellitus
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:Prevention of human diseases and conditions
UTAS Author:Yang, H (Ms Hilda Yang)
UTAS Author:Wright, L (Ms Leah Wright)
UTAS Author:Negishi, K (Dr Kazuaki Negishi)
UTAS Author:Marwick, TH (Professor Tom Marwick)
ID Code:141940
Year Published:2020
Web of Science® Times Cited:5
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-12-03
Last Modified:2022-08-25

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