Strategy to identify subjects with diabetes mellitus more suitable for selective echocardiographic screening: The DAVID-Berg study

Gori, Mauro; Canova, Paolo; Calabrese, Alice; Cioffi, Giovanni; Trevisan, Roberto; Maria, Renata De; Grosu, Aurelia; Iacovoni, Attilio; Fontana, Alessandra; Greene, Stephen J.; Gheorghiade, Mihai; Parati, Gianfranco; Gavazzi, Antonello; Senni, Michele

doi:10.1016/j.ijcard.2017.06.101

Cited by 5 publications

(3 citation statements)

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“…A predictive model was proposed based on clinical, ECG, and echocardiographic data. When diastolic dysfunction was assessed and computed into the model, the power to predict the risk of adverse events improved [61]. Thus, it may be worth devising screenings of diabetic subjects who meet certain criteria but do not yet experience the clinical symptoms of heart failure, in order to prevent related incidents.…”

Section: Left Ventricular Diastolic Dysfunctionmentioning

confidence: 99%

Left Ventricular Diastolic Dysfunction in Type 2 Diabetes—Progress and Perspectives

et al. 2019

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In-depth understanding of early cardiovascular manifestations in diabetes is high on international research and prevention agendas given that cardiovascular events are the leading cause of death for diabetic patients. Our aim was to review recent developments in the echocardiographic assessment of left ventricular diastolic dysfunction (LVDD) as a telltale pre-clinical disturbance preceding diabetic cardiomyopathy. We analyzed papers in which patients had been comprehensively assessed echocardiographically according to the latest LVDD guidelines (2016), and those affording comparisons with previous, widely used recommendations (2009). We found that the updated algorithm for LVDD is more effective in predicting adverse cardiovascular events in patients with established LVDD, and less specific in grading other patients (labelled “indeterminate”). This may prove instrumental for recruiting “indeterminate” LVDD cases among patients with type 2 diabetes mellitus (T2DM) in future screening programs. As an interesting consideration, the elevated values of the index E/e’ can point to early diastolic impairment, foretelling diabetic cardiomyopathy. Identifying subclinical signs early makes clinical sense, but the complex nature of T2DM calls for further research. Specifically, longitudinal studies on rigorously selected cohorts of diabetic patients are needed to better understand and predict the subtle, slow onset of cardiac manifestations with T2DM as a complicating backdrop.

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Section: Left Ventricular Diastolic Dysfunctionmentioning

confidence: 99%

Left Ventricular Diastolic Dysfunction in Type 2 Diabetes—Progress and Perspectives

et al. 2019

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“…The DAVID‐Berg study was a prospective cohort study carried out at three primary care group practices in northern Italy, comprising 10 general practitioners. In 2008, each primary care physician reviewed the clinical records of all subjects aged 55 to 80 years ( n = 4047).…”

Section: Methodsmentioning

confidence: 99%

Is mild asymptomatic left ventricular systolic dysfunction always predictive of adverse events in high‐risk populations? Insights from the DAVID‐Berg study

Gori

Redfield

Calabrese

et al. 2018

European J of Heart Fail

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“…The characteristics of the Detection of Asymptomatic VentrIcular Dysfunction in Bergamo (DAVID-Berg) study have been previously published. [10][11][12][13] Briefly, the DAVID-Berg was a prospective cohort study carried out at three primary care group practices in Bergamo, Italy. In 2008, each primary care physician reviewed the clinical records of all subjects aged 55-80 years (n ¼ 4047).…”

Section: Study Populationmentioning

confidence: 99%

Integrating natriuretic peptides and diastolic dysfunction to predict adverse events in high-risk asymptomatic subjects

Gori

Lam

D’Elia

et al. 2020

European Journal of Preventive Cardiology

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Background Natriuretic peptides and diastolic dysfunction have prognostic value in asymptomatic subjects at risk for heart failure. Their integration might further refine the risk stratification process in this setting. Aim of this paper was to explore the possibility to predict heart failure and death combining diastolic dysfunction and natriuretic peptides in an asymptomatic population at risk for heart failure. Methods Among 4047 subjects aged ≥55/≤80 years followed by 10 general practitioners in Italy, the DAVID-Berg study prospectively enrolled 623 asymptomatic outpatients at increased risk for heart failure. Baseline evaluation included electrocardiogram, echocardiogram, and natriuretic peptides collection. Based on diastolic dysfunction and natriuretic peptides, subjects were classified in four groups: control group (no diastolic dysfunction/normal natriuretic peptides, 57%), no diastolic dysfunction/high natriuretic peptides (9%), diastolic dysfunction/normal natriuretic peptides (24%), and diastolic dysfunction/high natriuretic peptides (11%). We applied Cox multivariable and Classification and Regression Tree analyses. Results The mean age of the population was 69 ± 7 years, 44% were women, mean left ventricular ejection fraction was 61%, and 35% had diastolic dysfunction. During a median follow-up of 5.7 years, 95 heart failure/death events occurred. Overall, diastolic dysfunction and natriuretic peptides were predictive of adverse events (respectively, hazard ratio 1.91, confidence interval 1.19–3.05, padjusted = 0.007, and hazard ratio 2.25, confidence interval 1.35–3.74, padjusted = 0.002) with Cox analysis. However, considering the four study subgroups, only the group with diastolic dysfunction/high natriuretic peptides had a significantly worse prognosis compared to the control group (hazard ratio 4.48, confidence interval 2.31–8.70, padjusted < 0.001). At Classification and Regression Tree analysis, diastolic dysfunction/high natriuretic peptides was the strongest prognostic factor (risk range 24–58%). Conclusions The DAVID-Berg data suggest that we look for the quite common combination of diastolic dysfunction/high natriuretic peptides to correctly identify asymptomatic subjects at greater risk for incident heart failure/death, thus more suitable for preventive interventions.

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Strategy to identify subjects with diabetes mellitus more suitable for selective echocardiographic screening: The DAVID-Berg study

Cited by 5 publications

References 50 publications

Left Ventricular Diastolic Dysfunction in Type 2 Diabetes—Progress and Perspectives

Left Ventricular Diastolic Dysfunction in Type 2 Diabetes—Progress and Perspectives

Is mild asymptomatic left ventricular systolic dysfunction always predictive of adverse events in high‐risk populations? Insights from the DAVID‐Berg study

Integrating natriuretic peptides and diastolic dysfunction to predict adverse events in high-risk asymptomatic subjects

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