Key result
In females with type 1 diabetes, higher E/e' was associated with increased risk of MACE (HR 1.15; 95% CI 1.07-1.24 per 1-unit increase), whereas this association was not significant in males.
Why the study?
Women with T1DM have a greater excess cardiovascular disease risk than men, and the prognostic value of echocardiographic myocardial function by sex in those without known heart disease was unclear.
Does echocardiographic myocardial function (E/e' and GLS) predict MACE and all-cause mortality differently in male and female patients with type 1 diabetes without known heart disease?
Cohort (n=1,079)
No
Does echocardiographic myocardial function (E/e' and GLS) predict MACE and all-cause mortality differently in male and female patients with type 1 diabetes without known heart disease?
Hazard Ratio: 1.15 (95% CI 1.07–1.24)
p-value: p=0.016
Echocardiographic markers of myocardial dysfunction (E/e' and GLS) provide independent prognostic information for MACE and mortality in females with type 1 diabetes, but not in males, highlighting a sex-specific cardiovascular risk profile.
Sex-specific echo parameters may refine CVD risk stratification in T1DM; leaves open whether thresholds improve outcomes or warrant targeted intervention.
AIMS: In type 1 diabetes mellitus (T1DM), recent findings suggest that women have a greater excess risk of cardiovascular diseases (CVDs) compared to men. Impaired diastolic function is a common feature in T1DM. We investigated the association between myocardial function by echocardiography and outcomes in T1DM males and females without known heart disease. METHODS AND RESULTS: A prospective cohort of individuals with T1DM without known heart disease from the outpatient clinic of Steno Diabetes Center Copenhagen. Follow-up was performed through Danish national registers. Outcomes, major adverse cardiovascular events (MACE) and all-cause mortality, were investigated. A total of 1079 participants (mean age: 49.6 ± 14.5 years, 52.6% male, mean duration of diabetes 25.8 ± 14.6 years) were included in the study. During follow-up (median 6.3 years, interquartile range 5.7-6.9), 142 (13.2%) experienced MACE and 63 (5.8%) died. Gender modified the relationship between E/e' and both MACE and all-cause mortality (P = 0.016 and 0.007, respectively). In females, after multivariable adjustment, both E/e' and global longitudinal strain (GLS) were significantly associated with MACE [E/e': hazard ratio (HR) 1.15 confidence interval (CI) 95%: 1.07-1.24, per 1unit increase; and GLS: HR 1.19 CI 95%: 1.04-1.35, per 1% decrease] and with all-cause mortality (E/e': HR 1.26 CI 95%: 1.11-1.44; and GLS: HR 1.27 CI 95%: 1.03-1.56). In males, the association between E/e' and GLS and outcomes did not reach statistical significance. CONCLUSION: In female individuals with T1DM both E/e' and GLS provided independent prognostic information, whereas the associations were not significant in males. These results suggest that T1DM affects myocardial function differently in males and females, which may be related to the observed sex difference in CVD risk in T1DM.
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Lassen et al. (2020) conducted a cohort in Type 1 diabetes mellitus without known heart disease (n=1,079). Myocardial function by echocardiography (E/e' and GLS) was evaluated on Major adverse cardiovascular events (MACE) (HR 1.15, 95% CI 1.07-1.24, p=0.016). In females with type 1 diabetes, higher E/e' was associated with increased risk of MACE (HR 1.15; 95% CI 1.07-1.24 per 1-unit increase), whereas this association was not significant in males.
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