Objectives: Diabetic cardiomyopathy (DCM) is an established complication of diabetes mellitus. In West Virginia, the especially high incidence of diabetes and heart failure validate the necessity of developing new strategies for earlier detection of DCM. Since most DCM patients remain asymptomatic until the later stages of the disease when the fibrotic complications become irreversible, we aimed to explore biomarkers that can identify early-stage DCM. Methods: The patients were grouped into 4 categories based on clinical diabetic and cardiac parameters: Control, Diabetes (DM), Diastolic dysfunction (DD), and Diabetes with diastolic dysfunction (DM+DD), the last group being the preclinical DCM group. Results: Echocardiography images indicated severe diastolic dysfunction in patients with DD+DM and DD compared to DM or control patients. In the DM and DM+DD groups, TNFα, isoprostane, and leptin were elevated compared to control (p<0.05), as were clinical markers HDL, glucose and hemoglobin A1C. Fibrotic markers IGFBP7 and TGF-β followed the same trend. The Control group showed higher beneficial levels of adiponectin and bilirubin, which were reduced in the DM and DM+DD groups (p<0.05). Conclusion: The results from our study support the clinical application of biomarkers in diagnosing early stage DCM, which will enable attenuation of disease progression prior to the onset of irreversible complications.

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Background: The ideal diagnostic test for suspicion of CAD in the emergency department (ED) is unknown. We developed the Buckeye Optimality Stress Score (BOSS) to assess ischemic evaluation (IE) appropriateness and impact on ED readmission. Methods: The BOSS score assigns points for each type of IE based upon published guidelines. We retrospectively calculated the BOSS score on all ED patients with IE orders (8/2017-11/2017). IE orders were assigned a category of optimal vs. suboptimal reflecting whether or not the IE with the highest BOSS score was used ( optimal ) or not ( suboptimal ). Results: In total, 251 patients were referred from the ED for IE (54 ± 12 years old, women 132 (53%)) of which 182 (73%) had a suboptimal BOSS score. The modality most likely to be optimal was CTA, accounting for 29 (44%) of all IE orders. Patients with diabetes, HTN and CAD were more likely to have a suboptimal BOSS. Cardiology was consulted in 75 (30%), and this was associated with higher CTA IE orders (26 (36%) vs. 26 (15%), p<0.001). Re-presentation to the ED was more likely in those with a suboptimal BOSS on initial IE order (11 (6.1%) vs. 0 (0%), p<0.04). Conclusion: The majority of IE orders from the ED received a suboptimal BOSS, perhaps indicating a gap in understanding of current IE guidelines. These patients were more likely to return to the ED for continued symptoms. Further prospective study of the utility of BOSS score in predicting recurrent presentation and subsequent testing is warranted.