Subclinical LV dysfunction and 10-year outcomes in type 2 diabetes mellitus

Holland, David J
Marwick, Thomas H
Haluska, Brian A
Leano, Rodel
Hordern, Matthew D
Hare, James L
Fang, Zhi You
Prins, Johannes B
Stanton, Tony

¹School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
²School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
³School of Human Movement Studies, The University of Queensland, Brisbane, Queensland, Australia
⁴Menzies Research Institute Tasmania, Hobart, Tasmania, Australia
⁵Heart Centre, The Alfred Hospital, Melbourne, Victoria, Australia
⁶Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia
⁷Mater Medical Research Institute Brisbane, Brisbane, Queensland, Australia

Dr Tony Stanton, School of Medicine, The University of Queensland, Level 4, The Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102, Australia; [email protected]

Received December 22, 2014

Received in revised form April 9, 2015

Accepted April 13, 2015

Heart 101(13):p 1061-1066, July 1, 2015. | DOI: 10.1136/heartjnl-2014-307391

Objective

New imaging techniques have permitted the detection of subclinical LV dysfunction (LVD) in up to half of patients with type 2 diabetes mellitus (DM) with a normal EF. However, the connection between early LVD and prognosis is unclear. This study aimed to define the long-term outcome of LVD associated with type 2 DM.

Methods

In this prospective cohort study, 230 asymptomatic patients with type 2 DM underwent measurement of global longitudinal 2D strain (GLS) for detection of LVD and were followed for up to 10 years. All subjects had normal EF (≥50%) and no evidence of coronary artery disease at recruitment. Outcome data were obtained through centralised state-wide death and hospital admission registries. The primary endpoint was all-cause mortality and hospitalisation.

Results

On study entry, almost half (45%) of the cohort had evidence of LVD as detected by GLS. Over a median follow-up of 7.4±2.6 years (range 0.6–9.7 years), 68 patients (30%) met the primary endpoint (LVD: 37%; normal LV function: 24%). GLS was independently associated with the primary endpoint (HR=1.10; p=0.04), as was systolic blood pressure (HR=1.02; p<0.001) and levels of glycosylated haemoglobin (HR=1.28; p=0.011). Patients with LVD had significantly worse outcome than those without (χ²=4.73; p=0.030).

Conclusions

Subclinical LVD is common in asymptomatic patients with type 2 DM, is readily detectable by GLS imaging and is independently associated with adverse outcome.

Trial registration number

Australian and New Zealand Clinical Trials Registry (ACTRN12612001178831).