Key result
Diastolic dysfunction in diabetic patients is linked to ~61% higher risk of developing HF.
Why the study?
Studies have reported a high prevalence of preclinical diastolic dysfunction in patients with diabetes mellitus, but the associated outcomes required evaluation.
Does preclinical diastolic dysfunction increase the risk of developing heart failure in patients with diabetes mellitus?
Cohort (n=1,760)
No
Does preclinical diastolic dysfunction increase the risk of developing heart failure in patients with diabetes mellitus?
Hazard Ratio: 1.61 (95% CI 1.17–2.2)
Absolute Event Rate: 36.9% vs 16.8%
p-value: p=0.003
Preclinical diastolic dysfunction, identified by an elevated E/e' ratio, independently predicts the development of heart failure and increased mortality in patients with diabetes mellitus.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The key takeaway is that diabetes mellitus alone is an independent risk factor for the development of heart failure. Our hope is that this study provides a strong foundation for further investigations into diabetes and heart failure. There is still much to learn and study in terms of this association and how to best diagnose and treat this condition.”
Preclinical diastolic dysfunction may flag higher HF risk in diabetes; leaves open whether screening or intervention improves outcomes.
Objectives Evaluate the outcomes of preclinical diastolic dysfunction in diabetic patients Background Studies have reported a high prevalence of preclinical diastolic dysfunction among patients with diabetes mellitus. Methods We identified all diabetic patients with a tissue Doppler assessment of diastolic function in Olmsted County, MN from 2001 to 2007. Diastolic dysfunction was defined as a Doppler mitral E/e′ ratio >15. The main outcome was the development of heart failure (HF). Secondary outcomes were the development of atrial fibrillation and death. Results Overall, 1,760 diabetic patients with a tissue Doppler echocardiographic assessment of diastolic function were identified; 411 patients (23%) had diastolic dysfunction. Using multivariable Cox's proportional hazard modeling, we determined that for every 1 unit increase in the mitral E/e′ ratio, the hazard of HF increased by 3% (HR=1.03, 95% CI=1.01-1.06; p=0.006) and that diastolic dysfunction was associated with the subsequent development of HF after adjustment for age, sex, body mass index, hypertension, coronary disease and echocardiographic parameters (HR=1.61, 95% CI=1.17-2.20; p=0.003). The cumulative probability of the development of HF at 5 years for diabetic patients with diastolic dysfunction was 36.9% compared to 16.8% for patients without diastolic dysfunction (P<0.001). Furthermore, diabetic patients with diastolic dysfunction had a significantly higher mortality compared to those without diastolic dysfunction. Conclusion We demonstrated that an increase in the E/e′ ratio in diabetic patients is associated with the subsequent development of HF and increased mortality independent of hypertension, coronary disease or other echocardiographic parameters.
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From et al. (2010) conducted a cohort in Diabetes Mellitus (n=1,760). Diastolic dysfunction (Doppler mitral E/e′ ratio >15) vs. No diastolic dysfunction was evaluated on Development of heart failure (HF) (HR 1.61, 95% CI 1.17-2.20, p=0.003). Diastolic dysfunction in diabetic patients was associated with a higher 5-year risk of developing heart failure compared to those without dysfunction (36.9% vs 16.8%; HR 1.61, 95% CI 1.17-2.20).
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