In elderly patients with asymptomatic type 2 diabetes, there is a high risk for subclinical left ventricular (LV) dysfunction, according to a study published in JACC: Cardiovascular Imaging.
In addition, the study demonstrated that impaired global longitudinal strain (GLS), which measures LV strain, may be predictive of incident heart failure (HF) in this patient population.
Asymptomatic patients with type 2 diabetes (aged ≥65 years) who presented with preserved ejection fraction and no evidence of ischemic heart disease were enrolled in this prospective study (n=290). A comprehensive echocardiogram, which included evaluation of LV hypertrophy, left atrial enlargement, diastolic dysfunction, and GLS, was performed for all patients. Investigators followed patients for a median of 1.5 years, using telephone calls and surveys to detect HF symptoms. The primary composite end point for this study comprised new-onset HF and all-cause mortality.
Approximately 10% of the study cohort had LV dysfunction by diastolic dysfunction, whereas LV dysfunction was observed in 23%, 35%, and 23% of patients by LV hypertrophy, left atrial enlargement, and GLS, respectively. During follow-up, a total of 45 patients had developed new-onset HF and 4 patients had died. These outcomes translated to an event rate of 112/1000 person-years.
In patients with any abnormality on echocardiogram vs patients with a normal echocardiogram, survival free of the composite end point was 1.5-fold higher. Factors associated with an increased risk for the composite end point included LV hypertrophy, left atrial enlargement, and GLS. Also, factors significantly associated with incident HF included LV hypertrophy (hazard ratio, 2.90; P <.001) and GLS <16% (hazard ratio, 2.26; P =.008).
The lack of information on other biomarkers associated with HF represented a potential limitation of this study.
The investigators concluded that “impaired GLS adds incremental prognostic value to glycemic control,” and “[t]he detection of early myocardial dysfunction may allow identification of asymptomatic patients with [type 2 diabetes] who are at risk of developing symptomatic HF.”
Wang Y, Yang H, Huynh Q, et al. Diagnosis of non-ischemic stage B heart failure in type 2 diabetes mellitus: optimal parameters for prediction of heart failure [published online May 10, 2018]. JACC: Cardiovasc Imag. doi:10.1016/j.jcmg.2018.03.015