Subclinical LV dysfunction and 10-year outcomes in type 2 diabetes mellitus

• Published in: Heart (British Cardiac Society) Vol. 101; no. 13; pp. 1061 - 1066
• Main Authors: Holland, David J, Marwick, Thomas H, Haluska, Brian A, Leano, Rodel, Hordern, Matthew D, Hare, James L, Fang, Zhi You, Prins, Johannes B, Stanton, Tony
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.07.2015
• Subjects: Acute coronary syndromes; Aged; Asymptomatic Diseases; Australia - epidemiology; Cardiovascular disease; Coronary vessels; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Early Diagnosis; Echocardiography - methods; Female; Heart attacks; Heart failure; Hospitals; Humans; Middle Aged; Mortality; New Zealand - epidemiology; Prognosis; Prospective Studies; Recruitment; Time; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; New Zealand; Australia
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2014-307391

ObjectiveNew imaging techniques have permitted the detection of subclinical LV dysfunction (LVD) in up to half of patients with type 2 diabetes mellitus (DM) with a normal EF. However, the connection between early LVD and prognosis is unclear. This study aimed to define the long-term outcome of LVD associated with type 2 DM.MethodsIn this prospective cohort study, 230 asymptomatic patients with type 2 DM underwent measurement of global longitudinal 2D strain (GLS) for detection of LVD and were followed for up to 10 years. All subjects had normal EF (≥50%) and no evidence of coronary artery disease at recruitment. Outcome data were obtained through centralised state-wide death and hospital admission registries. The primary endpoint was all-cause mortality and hospitalisation.ResultsOn study entry, almost half (45%) of the cohort had evidence of LVD as detected by GLS. Over a median follow-up of 7.4±2.6 years (range 0.6–9.7 years), 68 patients (30%) met the primary endpoint (LVD: 37%; normal LV function: 24%). GLS was independently associated with the primary endpoint (HR=1.10; p=0.04), as was systolic blood pressure (HR=1.02; p<0.001) and levels of glycosylated haemoglobin (HR=1.28; p=0.011). Patients with LVD had significantly worse outcome than those without (χ2=4.73; p=0.030).ConclusionsSubclinical LVD is common in asymptomatic patients with type 2 DM, is readily detectable by GLS imaging and is independently associated with adverse outcome.Trial registration numberAustralian and New Zealand Clinical Trials Registry (ACTRN12612001178831).