The E/e’ ratio difference between subjects with type 2 diabetes and controls. A meta-analysis of clinical studies

• Published in: PloS one Vol. 13; no. 12; p. e0209794
• Main Authors: Zoppini, Giacomo, Bergamini, Corinna, Mantovani, Alessandro, Dauriz, Marco, Targher, Giovanni, Rossi, Andrea, Bonora, Enzo
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 27.12.2018; Public Library of Science (PLoS)
• Subjects: Asymmetry; Between-subjects design; Biology and life sciences; Cardiology; Cardiomyopathy; Cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - physiopathology; Complications and side effects; Control; Cross-Sectional Studies; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Doppler effect; Echocardiography; Endocrinology; Glucose; Health care; Health risks; Heart diseases; Heart failure; Heart Failure - etiology; Heart Failure - physiopathology; Hemoglobin; Humans; Hypertension; Inspection; Medicine; Medicine and Health Sciences; Meta-analysis; Metabolism; Mortality; Patients; Physical Sciences; Research and Analysis Methods; Risk factors; Sensitivity; Sensitivity analysis; Studies; Subgroups; Systematic review; Type 2 diabetes; Ventricle; Italy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0209794

Type 2 diabetes is associated with an increased risk of heart failure. Left ventricular diastolic dysfunction and type 2 diabetes are frequently associated. Using echocardiography, we know that tissue Doppler imaging E/e' ratio is a reliable predictor of left ventricular filling pressure. We performed a systematic review and meta-analysis to investigate the averaged E/e' ratio value in patients with type 2 diabetes compared to non-diabetic controls. In the analysis we included cross-sectional studies providing the averaged E/e' ratio. Subgroup/sensitivity analyses were conducted according to variables known to influence E/e' ratio measurements. The analysis included 15 cross sectional studies with 877 type 2 diabetes patients and 1193 controls. The weighted mean difference showed higher values in diabetes (WMD 2.02; 95% CI 1.35, 2.70; p<0.001). The result was consistent in the subgroup/sensitivity analyses. Visual inspection of the funnel plot did not identify substantial asymmetry and the Egger test for funnel plot asymmetry showed a p value of 0.36. In conclusion, our assessment suggests that averaged E/e' ratio is consistently increased in patients with type 2 diabetes compared to non-diabetic controls in the absence of cardiovascular diseases and complicated hypertension. This alteration may be a precocious diastolic alteration in the diabetic cardiomyopathy.