Key result
Higher E/e'sr was significantly associated with MACE (HR 1.16; 95% CI 1.05-1.29; p=0.005) and all-cause mortality, with the MACE association remaining significant only in females.
Why the study?
Impaired diastolic function is common in T1DM, and the prognostic value of E/e'sr compared to E/e' in patients without known heart disease required investigation.
Does the echocardiographic E/e'sr ratio provide prognostic value for mortality and MACE compared to E/e' in patients with type 1 diabetes without known heart disease?
Cohort (n=1,079)
Yes
Does the echocardiographic E/e'sr ratio provide prognostic value for mortality and MACE compared to E/e' in patients with type 1 diabetes without known heart disease?
Hazard Ratio: 1.16 (95% CI 1.05–1.29)
p-value: p=0.005
E/e'sr provides independent prognostic information for MACE and mortality in T1DM patients, with particularly strong prognostic value in females.
May support refined risk stratification in T1DM; leaves open incremental value over E/e' and requires prospective validation.
BACKGROUND: Impaired diastolic function is a hallmark of diabetic cardiomyopathy and a common feature in type 1 diabetes mellitus (T1DM). The ratio of transmitral early filling velocity to early diastolic strain rate (E/e'sr) has in recent studies proved to have strong prognostic value. This study aimed to investigate the prognostic value of E/e'sr compared to E/e' in T1DM without known heart disease. METHODS: In this prospective cohort of T1DM patients, echocardiography was performed including two-dimensional speckle tracking. Follow-up was performed using nationwide registries. Outcomes were all-cause mortality and major cardiovascular events (MACE). RESULTS: In total 1079 patients (age: 49.6 ± 14.5 years, 52.5% male, duration of diabetes 25.8 ± 14.6 years) were included in the study. During follow-up (median 6.3 years, IQR:5.7-6.9) 13.2% experienced MACE and 5.8% died. Following multivariable adjustment, both E/e'sr and E/e' was significantly associated with both MACE (E/e'sr: HR 1.16 CI95%:[1.05-1.29], p = 0.005, per 10 cm increase) vs. (E/e': HR 1.09 CI95%:[1.03-1.15], p = 0.001, per 1 unit increase) and all-cause mortality (E/e'sr: HR 1.20 [1.03-1.40], p = 0.016) vs. (E/e': HR: 1.11 [1.02-1.20], p = 0.016). Sex modified the association between E/e'sr and MACE (p for interaction = 0.008) such that E/e'sr after multivariable adjustment only remained significantly associated with MACE in females (HR: 1.41 [1.19-1.67], p < 0.001) but not in males (HR: 1.06 [0.93-1.20], p = 0.42). In females, E/e'sr provided incremental information beyond the Steno T1 Risk Engine (Harrell's C-statistic: 0.78 (0.72-0.83) vs. 0.81 (0.75-0.86), p = 0.007). CONCLUSION: In patients with T1DM, both E/e'sr and E/e' provides independent prognostic information regarding prognosis. E/e'sr seems to have stronger prognostic value in females with T1DM.
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Lassen et al. (2023) conducted a cohort in Type 1 diabetes mellitus without known heart disease (n=1,079). Ratio of transmitral early filling velocity to early diastolic strain rate (E/e'sr) vs. E/e' was evaluated on Major cardiovascular events (MACE) (HR 1.16, 95% CI 1.05-1.29, p=0.005). Higher E/e'sr was significantly associated with MACE (HR 1.16; 95% CI 1.05-1.29; p=0.005) and all-cause mortality, with the MACE association remaining significant only in females.
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