The impact of diabetes on clinical outcomes in patients with pseudonormal left ventricular diastolic filling pattern and preserved ejection fraction

Type 2 diabetes mellitus (DM) is a risk factor for the development of heart failure (HF) and associated with a poor prognosis. However, the impact of DM on clinical outcomes in patients with left ventricular diastolic dysfunction (LVDD) and HF with preserved ejection fraction (EF), which is the phenotype of diabetic cardiomyopathy, remains uncertain. This study aimed to investigate the impact of DM on cardiac functional changes and prognosis in patients with pseudonormal LV diastolic filling pattern (LVDFP) and preserved EF. A total of 413 patients with pseudonormal LVDFP and preserved EF who underwent follow-up echocardiography were enrolled between 2011 and 2020. The primary outcome was major adverse cardiac events (MACE) including all-cause death, non-fatal myocardial infarction, cardiac hospitalization, or stroke. Among the study population, 125 patients (30.3%) had DM. During the follow-up period (median 3.8 years [interquartile range: 2.1 to 5.6 years]), the follow-up EF comparing baseline EF was more significantly decreased in DM patients (67.3 ± 6.3 to 64.8 ± 7.5; p = 0.001) compared with non-DM patients (67.8 ± 5.8 to 66.8 ± 6.9; p = 0.03). Furthermore, compared with the non-DM patients, the DM patients significantly increased the risk of MACE (26.2% vs. 54.7%; adjusted hazard ratio, 1.68; 95% confidence interval, 1.11-2.54; p = 0.015). In patients with pseudonormal LVDFP and preserved EF, the DM was associated with the risk of worse clinical outcomes compared with the non-DM.