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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
Date Published2018 10
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

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.

Alternate JournalJACC Cardiovasc Imaging
PubMed ID29778859