Diastolic dysfunction and diabetes: the DIADAD study—a retrospective cohort study from Liverpool

Abstract Background Diastolic dysfunction is an important early indicator of heart failure (HF) with preserved ejection fraction (HFpEF). Type 2 diabetes mellitus (T2DM) may contribute to HFpEF, as it is associated with an increased risk of hospitalization and mortality. Aim To investigate the association between diastolic dysfunction and T2DM in an adult population from Liverpool, accounting for age and sex. Methods A retrospective review of 493 patient records was conducted, extracting data on diastolic function status, diabetes status, age, and sex. Echocardiographic parameters were used to assess and grade diastolic function according to the 2016 ASE/EACVI recommendations. Results Diastolic dysfunction was more prevalent in type 2 diabetics (71.42%) than non-diabetic patients (43.98%) (P .05). The odds ratio of developing diastolic dysfunction was 2.636 times higher in diabetics, with 2.56 times greater odds of a higher dysfunction grade (P .001). Age ≥65 years was associated with 4.65 times higher odds of having diastolic dysfunction, with no significant difference between genders. Conclusions This retrospective cohort study demonstrates a clear and statistically significant association between T2DM, advancing age and diastolic dysfunction. This association, however, should be interpreted within the context of a clinically selected population undergoing echocardiography. Due to the metabolic alterations that are associated with diabetes and the pathophysiology of HFpEF, there is a great potential for the use antidiabetic therapies as cardioprotective agents aimed at reducing HF morbidity and mortality. Considering these results, we propose incorporating diabetes into the H2FpEF score. Key messages What is already known on this topic – the development of heart failure with preserved ejection fraction (HFpEF) has long been associated with type 2 diabetes mellitus (T2DM), with the recognition of diastolic dysfunction as an early marker of disease progression. However, data describing the relationship between diabetes and diastolic dysfunction in specific local populations remains limited. What this study adds – this study provides data from a Liverpool tertiary centre showcasing significantly higher prevalence and severity of diastolic dysfunction in patients with type 2 diabetes. These findings produce locally relevant epidemiological evidence that supports the association between diabetes and diastolic dysfunction. How this study might affect research, practice or policy – the findings of this study highlight the importance of cardiovascular assessment in patients with type 2 diabetes in certain populations with a high burden of diabetes, such as Liverpool, and may support earlier identification of individuals at risk of developing HFpEF. Future research might consider incorporating T2DM into the H₂FPEF score, to improve early risk stratification.