Key result
Clinical risk scores and biomarkers showed weak relationships with subclinical left ventricular dysfunction in patients with type 2 diabetes, providing poor discrimination (AUC 63% for abnormal GLS).
Why the study?
Subclinical LV dysfunction identifies HF risk in T2DM, but the association of clinical scores and biomarkers with subclinical LV dysfunction to guide echocardiography was unknown.
Do clinical scores (ARIC-HF, WATCH-DM) and biomarkers (NTpBNP, hs-TnT) accurately identify subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus?
Cross-Sectional (n=804)
Yes
Do clinical scores (ARIC-HF, WATCH-DM) and biomarkers (NTpBNP, hs-TnT) accurately identify subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus?
Effect estimate: AUC 63%
Clinical risk scores and biomarkers (NT-proBNP, hs-TnT) have poor discriminatory ability for identifying subclinical left ventricular dysfunction in patients with type 2 diabetes, suggesting they cannot reliably replace echocardiographic screening.
May aid LVD identification in T2DM; leaves open whether scores or biomarkers can select patients for echocardiography.
Background Subclinical LV dysfunction (LVD) identifies heart failure (HF) risk in type 2 diabetes mellitus (T2DM). We sought the extent to which clinical scores (ARIC-HF, WATCH-DM), natriuretic peptides (NTpBNP) and troponin (hs-TnT) were associated with subclinical LV dysfunction (LVD). These associations could inform the ability of these tests to identify which patients should undergo echocardiography. Methods Participants with T2DM were prospectively recruited from three community-based populations. ARIC-HF risk at 4 years and WATCH-DM scores were calculated from clinical data. NTpBNP and hs-TnT were measured using an electro-chemiluminescence assay. All underwent a comprehensive echocardiogram. We calculated the sensitivity and specificity of clinical scores and biomarkers to identify abnormal global longitudinal strain (GLS ≥ −16%)), diastolic function (E/e’ ≥ 14 or e’ < 8 cm/s), left atrial volume index (LAV > 34 ml/m2) and LV hypertrophy (LV mass index > 88 g/m2 (F) > 102 g/m2(M)). Results Of 804 participants (median age 69 years [inter-quartile range (IQR) 65–73], 36% female), clinical scores suggested significant HF risk (median ARIC-HF 8% [IQR 4–12]; WATCH-DM 10 points [IQR 8–12]), and the median NTpBNP was 50 pg/mL [IQR 25–101] and hs-TnT 9.6 pg/mL [IQR 6.8–13.6]. Abnormal GLS was present in 126 (17%), elevated E/e’ in 114 (15%), impaired e’ in 629 (78%), increased LAV in 351 (44%) and LV hypertrophy in 113 (14%). After adjustments for age, body-mass index, and renal function, each standard deviation increase in NTpBNP was associated with a GLS increase of 0.32 (p < 0.001) and hs-TnT increase by 0.26 (p < 0.001). Similar trends were observed with ARIC-HF (standardised β = 0.22, p < 0.001) and WATCH-DM (standardised β = 0.22, p < 0.001) in univariable analyses. However, none of the risk assessment tools provided satisfactory discrimination for abnormal GLS (AUC 63%), diastolic indices (e’ AUC 54–61%) or LV mass (AUC 59–67%). At a sensitivity of 90%, there was an unacceptably low (< 50%) specificity. Conclusion Although risk assessment based on clinical scores or biomarkers would be desirable to stratify HF risk in people with T2DM, they show a weak relationship with subclinical LVD.
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Halabi et al. (2022) conducted a cross-sectional in Type 2 diabetes mellitus (n=804). Clinical risk scores (ARIC-HF, WATCH-DM) and biomarkers (NTpBNP, hs-TnT) vs. Normal echocardiographic parameters was evaluated on Discrimination of abnormal global longitudinal strain (GLS ≥ -16%) (AUC 63%). Clinical risk scores and biomarkers showed weak relationships with subclinical left ventricular dysfunction in patients with type 2 diabetes, providing poor discrimination (AUC 63% for abnormal GLS).
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