Association of biomarkers and risk scores with subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus

Abstract

Background Subclinical LV dysfunction (LVD) identifies heart failure (HF) risk in type 2 diabetes mellitus (T2DM). We sought the extent to which clinical scores (ARIC-HF, WATCH-DM), natriuretic peptides (NTpBNP) and troponin (hs-TnT) were associated with subclinical LV dysfunction (LVD). These associations could inform the ability of these tests to identify which patients should undergo echocardiography. Methods Participants with T2DM were prospectively recruited from three community-based populations. ARIC-HF risk at 4 years and WATCH-DM scores were calculated from clinical data. NTpBNP and hs-TnT were measured using an electro-chemiluminescence assay. All underwent a comprehensive echocardiogram. We calculated the sensitivity and specificity of clinical scores and biomarkers to identify abnormal global longitudinal strain (GLS ≥ −16%)), diastolic function (E/e’ ≥ 14 or e’ < 8 cm/s), left atrial volume index (LAV > 34 ml/m2) and LV hypertrophy (LV mass index > 88 g/m2 (F) > 102 g/m2(M)). Results Of 804 participants (median age 69 years [inter-quartile range (IQR) 65–73], 36% female), clinical scores suggested significant HF risk (median ARIC-HF 8% [IQR 4–12]; WATCH-DM 10 points [IQR 8–12]), and the median NTpBNP was 50 pg/mL [IQR 25–101] and hs-TnT 9.6 pg/mL [IQR 6.8–13.6]. Abnormal GLS was present in 126 (17%), elevated E/e’ in 114 (15%), impaired e’ in 629 (78%), increased LAV in 351 (44%) and LV hypertrophy in 113 (14%). After adjustments for age, body-mass index, and renal function, each standard deviation increase in NTpBNP was associated with a GLS increase of 0.32 (p < 0.001) and hs-TnT increase by 0.26 (p < 0.001). Similar trends were observed with ARIC-HF (standardised β = 0.22, p < 0.001) and WATCH-DM (standardised β = 0.22, p < 0.001) in univariable analyses. However, none of the risk assessment tools provided satisfactory discrimination for abnormal GLS (AUC 63%), diastolic indices (e’ AUC 54–61%) or LV mass (AUC 59–67%). At a sensitivity of 90%, there was an unacceptably low (< 50%) specificity. Conclusion Although risk assessment based on clinical scores or biomarkers would be desirable to stratify HF risk in people with T2DM, they show a weak relationship with subclinical LVD.

Use of the energy waveform electrocardiogram to detect subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus

“…The feasibility of NT-proBNP makes this an attractive option for annual testing [ 6 ]. However, while NT-proBNP is valuable for the recognition of unrecognized HF, it may be less sensitive in the recognition of LV dysfunction that is insufficiently advanced to increase myocardial wall stress [ 10 ]. A threshold of 125 pg/mL NT-proBNP is widely used in the diagnosis of acute HF [ 38 ], albeit as a “rule-out” test [ 39 ].…”

“…This is mainly because comorbidities such as renal diseases, obesity and other cardiovascular diseases (CVD) may also result in the elevation of NT-proBNP value [ 9 ]. In our recent experience, neither clinical assessment nor NT-proBNP provided satisfactory discrimination for abnormal GLS (AUC 63%), diastolic indices (e′, AUC 54–61%) or LV mass (AUC 59–67%), and the high sensitivity needed for a screening test was attained only with an unacceptably low (< 50%) specificity [ 10 ]. An alternate approach in SBHF screening is the application of the Atherosclerosis Risk in Communities (ARIC) HF risk score, which consists of various risk factors such as age, sex, race, comorbidities and vital signs [ 11 ].…”

Biomarkers and subclinical left ventricular dysfunction in patients with type 2 diabetes without clinical manifestations of cardiovascular diseases

“…"Несовершенство" НУП продемонстрировано еще в одном исследовании [27]. Его целью было изучение возможности диагностики СДЛЖ или структурной болезни сердца у группы населения с СД2 с помощью биомаркеров (NT-proBNP и вчсTnT) и клинических шкал риска СН, валидированных в исследованиях ARIC-HF (Atherosclerosis Risk In Communities-Heart Failure) и WATCH-DM (Weight, Age, Hypertension, Creatinine, High-Density Lipoprotein Cholesterol-Diabetes Mellitus).…”

Association between glycosylated hemoglobin levels, diabetes duration, and left ventricular diastolic dysfunction in patients with type 2 diabetes and preserved ejection fraction: a cross-sectional study

“…Diabetes stands as an independent risk factor for both left ventricular hypertrophy and congestive heart failure (HF), with diabetic patients experiencing a more adverse prognosis in heart failure compared to their non-diabetic counterparts ( 1 ). The trajectory of diabetic cardiomyopathy (DCM) unfolds as diabetes initiates diastolic dysfunction, progresses to systolic dysfunction, and culminates in refractory HF, unrelated to hypertension, coronary heart disease, or valvular disease.…”

“…Cardiac complications in patients with diabetes often raise concerns only when overt symptomatic heart failure manifests. While cardiac magnetic resonance imaging (CMRI) is considered the gold standard for assessing ventricular diastolic function ( 1 , 12 ), its use remains limited in clinical settings. Recent advancements in echocardiography technology position it as the primary choice for most clinical practices.…”