The Development of Heart Failure in Patients With Diabetes Mellitus and Pre-Clinical Diastolic Dysfunction. A Population-Based Study

Aaron M. From, Christopher G. Scott, Horng H. Chen

Research output: Contribution to journalArticlepeer-review

284 Scopus citations

Abstract

Objectives: The purpose of this study was to evaluate the outcomes of pre-clinical diastolic dysfunction in diabetic patients. Background: Studies have reported a high prevalence of pre-clinical diastolic dysfunction among patients with diabetes mellitus. Methods: We identified all diabetic patients with a tissue Doppler imaging assessment of diastolic function in Olmsted County, Minnesota, from 2001 to 2007. Diastolic dysfunction was defined as a passive transmitral left ventricular (LV) inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (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 (23%) patients had diastolic dysfunction. Using multivariable Cox's proportional hazard modeling, we determined that for every 1-U increase in the passive transmitral LV inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (E/e′) ratio, the hazard ratio (HR) of HF increased by 3% (HR: 1.03; 95% confidence interval [CI]: 1.01 to 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 to 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 with 16.8% for patients without diastolic dysfunction (p < 0.001). Furthermore, diabetic patients with diastolic dysfunction had a significantly higher mortality rate compared with those without diastolic dysfunction. Conclusions: We demonstrated that an increase in the passive transmitral LV inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (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.

Original languageEnglish (US)
Pages (from-to)300-305
Number of pages6
JournalJournal of the American College of Cardiology
Volume55
Issue number4
DOIs
StatePublished - Jan 26 2010

Keywords

  • diabetes mellitus
  • diabetic cardiomyopathy
  • diastolic dysfunction
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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