The Development of Heart Failure in Patients With Diabetes Mellitus and Pre-Clinical Diastolic Dysfunction

Abstract

Objectives Evaluate the outcomes of preclinical diastolic dysfunction in diabetic patients Background Studies have reported a high prevalence of preclinical diastolic dysfunction among patients with diabetes mellitus. Methods We identified all diabetic patients with a tissue Doppler assessment of diastolic function in Olmsted County, MN from 2001 to 2007. Diastolic dysfunction was defined as a Doppler mitral E/e′ ratio >15. The main outcome was the development of heart failure (HF). Secondary outcomes were the development of atrial fibrillation and death. Results Overall, 1,760 diabetic patients with a tissue Doppler echocardiographic assessment of diastolic function were identified; 411 patients (23%) had diastolic dysfunction. Using multivariable Cox's proportional hazard modeling, we determined that for every 1 unit increase in the mitral E/e′ ratio, the hazard of HF increased by 3% (HR=1.03, 95% CI=1.01-1.06; p=0.006) and that diastolic dysfunction was associated with the subsequent development of HF after adjustment for age, sex, body mass index, hypertension, coronary disease and echocardiographic parameters (HR=1.61, 95% CI=1.17-2.20; p=0.003). The cumulative probability of the development of HF at 5 years for diabetic patients with diastolic dysfunction was 36.9% compared to 16.8% for patients without diastolic dysfunction (P<0.001). Furthermore, diabetic patients with diastolic dysfunction had a significantly higher mortality compared to those without diastolic dysfunction. Conclusion We demonstrated that an increase in the E/e′ ratio in diabetic patients is associated with the subsequent development of HF and increased mortality independent of hypertension, coronary disease or other echocardiographic parameters.

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

“…It was as high as 61% in the Urban Baltimore Community Registry 101. Diabetes hastens the transition from preclinical diastolic dysfunction to HFpEF and is associated with a nearly 2‐fold increase in mortality and morbidity in HFpEF 274, 275, 276, 277. Insulin resistance and hyperglycemia affect HFpEF patients through multiple mechanisms 278.…”

Doppler Echocardiography Evaluation of the Relationship between Insulin Resistance and Early Diastolic Dysfunction in Prediabetes Patients

“…The results which support these findings could be encountered in two similar studies in patients with prediabetes [7]. Moreover, studies that have been done with patients who have diabetes, obesity and metabolic syndrome provided similar findings; and, insulin resistance in three of the groups seemed to be the main cause [8][9][10]. The relationship between insulin resistance and myocardial performance has not been highlighted and explained adequately.…”

Is diabetic cardiomyopathy a specific entity?

“…Diastolic abnormalities have been reported in 23% to 75% of patients with DM [42][43][44][45] . A high variability in the prevalence of diastolic dysfunction raises a question on the implemented methodology.…”