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Diagnosis of Nonischemic Stage B Heart Failure in Type 2 Diabetes Mellitus: Optimal Parameters for Prediction of Heart Failure.

TitleDiagnosis of Nonischemic Stage B Heart Failure in Type 2 Diabetes Mellitus: Optimal Parameters for Prediction of Heart Failure.
Publication TypeJournal Article
Year of Publication2018
AuthorsWang Y, Yang H, Huynh Q, Nolan M, Negishi K
Secondary AuthorsMarwick TH
JournalJACC Cardiovasc Imaging
Volume11
Issue10
Pagination1390-1400
Date Published2018 10
ISSN1876-7591
KeywordsAged, Asymptomatic Diseases, Diabetes Mellitus, Type 2, Diabetic Cardiomyopathies, Echocardiography, Doppler, Female, Heart Failure, Humans, Hypertrophy, Left Ventricular, Incidence, Male, Predictive Value of Tests, Prevalence, Progression-Free Survival, Prospective Studies, Risk Factors, Stroke Volume, Tasmania, Time Factors, Ventricular Dysfunction, Left, Ventricular Function, Left
Abstract

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 mellitus ≥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 (

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 GLS 

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.

DOI10.1016/j.jcmg.2018.03.015
Alternate JournalJACC Cardiovasc Imaging
PubMed ID29778859