Diagnosis of Nonischemic Stage B Heart Failure in Type 2 Diabetes Mellitus

Wang, Ying; Yang, Hong; Huynh, Quan; Nolan, Mark; Negishi, Kazuaki; Marwick, Thomas H.

doi:10.1016/j.jcmg.2018.03.015

Cited by 62 publications

(68 citation statements)

References 30 publications

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“…Moreover, despite these exclusions, Yang et al reported an HF incidence rate of~100 per 1000 person years, which was~nine-fold higher than we observed in the SCREEN-HF cohort. 5 In contrast to the studies of Yang et al and Wang et al, 5,6 we found that LS made little contribution to the prediction of symptomatic HF when added to either ASE/EACVI or ARIC SBHF criteria. The importance of this observation is that LVEF is an established echocardiographic parameter that can be measured in almost all patients, whereas reliable LS measurement may not be possible in the same high proportion of echocardiographic examinations.…”

Section: Discussioncontrasting

confidence: 97%

“…For example, Yang et al defined SBHF as at least one of LVM/BSA >115 g/m 2 for men or >95 g/m 2 for women, LAV/BSA >34 mL/m 2 , average E/e 0 >13, and LS >À18%. 5, 6 Yang et al reported a sensitivity of 82% and specificity of 41% for the prediction of symptomatic HF by their SBHF algorithm in asymptomatic patients ≥65 years of age with at least one HF risk factor, 5 which is comparable with the 81% sensitivity and 39% specificity we obtained in the SCREEN-HF cohort for ARIC SBHF criteria alone. 6 Neither definition included LVEF.…”

Section: Discussionsupporting

confidence: 55%

“…5 Wang et al used a similar definition except that the LS cut point was >À16%. 6 Neither definition included LVEF. 5,6 Yang et al reported a sensitivity of 82% and specificity of 41% for the prediction of symptomatic HF by their SBHF algorithm in asymptomatic patients ≥65 years of age with at least one HF risk factor, 5 which is comparable with the 81% sensitivity and 39% specificity we obtained in the SCREEN-HF cohort for ARIC SBHF criteria alone.…”

Section: Discussionmentioning

confidence: 99%

“…1 Stage A HF refers to asymptomatic individuals with cardiovascular disease (CVD) risk factors but without structural heart disease, whereas Stage B HF (SBHF) refers to asymptomatic individuals with structural heart disease, which may include any of LV dilatation, LV hypertrophy (LVH), reduced LV ejection fraction (LVEF), wall motion abnormalities (WMAs), and moderate or greater aortic or mitral stenosis or regurgitation. [3][4][5][6] Age-related changes in cardiac structure and function are well recognized, including smaller LV size, greater LVEF, and lower early diastolic mitral annular tissue Doppler velocities (TDI e 0 ). There has been discussion about how best to define SBHF with respect to cut-offs for LV dimensions, LVH, and LVEF, and whether inclusion of diastolic dysfunction (DD) and longitudinal strain (LS) as part of SBHF criteria improves the prediction of symptomatic HF.…”

Section: Introductionmentioning

confidence: 99%

“…There has been discussion about how best to define SBHF with respect to cut-offs for LV dimensions, LVH, and LVEF, and whether inclusion of diastolic dysfunction (DD) and longitudinal strain (LS) as part of SBHF criteria improves the prediction of symptomatic HF. [3][4][5][6] Age-related changes in cardiac structure and function are well recognized, including smaller LV size, greater LVEF, and lower early diastolic mitral annular tissue Doppler velocities (TDI e 0 ). 7,8 The American Society of Echocardiography and European Association of Cardiovascular Imaging (ASE/EACVI) guideline describes normal ranges based on populations with mean ages ranging from 37 to 50 years, 7 whereas the Atherosclerosis Risk in Communities (ARIC) study defined 95th percentile limits derived from the ARIC study healthy subgroup aged 67-91 years.…”

Section: Introductionmentioning

confidence: 99%

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Age‐specific diastolic dysfunction improves prediction of symptomatic heart failure by Stage B heart failure

et al. 2019

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Aims We investigated whether addition of diastolic dysfunction (DD) and longitudinal strain (LS) to Stage B heart failure (SBHF) criteria (structural or systolic abnormality) improves prediction of symptomatic HF in participants of the SCReening Evaluation of the Evolution of New Heart Failure study, a self‐selected population at increased cardiovascular disease risk recruited from members of a health insurance fund in Melbourne and Shepparton, Australia. Both American Society of Echocardiography and European Association of Cardiovascular Imaging (ASE/EACVI) criteria and age‐specific Atherosclerosis Risk in Communities (ARIC) study criteria, for SBHF and DD, and ARIC criteria for abnormal LS, were examined. Methods and results Inclusion criteria were age ≥60 years with one or more of self‐reported ischaemic or other heart disease, irregular or rapid heart rhythm, cerebrovascular disease, renal impairment, or treatment for hypertension or diabetes for ≥2 years. Exclusion criteria were known HF, or ejection fraction <50% or >mild valve abnormality detected on previous echocardiography or other imaging. Echocardiography was performed in 3190 participants who were followed for a median of 3.9 (interquartile range: 3.4, 4.5) years after echocardiography. Symptomatic HF was diagnosed in 139 participants at a median of 3.1 (interquartile range: 2.1, 3.9) years after echocardiography. ARIC structural, systolic, and diastolic abnormalities predicted HF in univariate and multivariable proportional hazards analyses, whereas ASE/EACVI structural and systolic, but not diastolic, abnormalities predicted HF. ARIC and ASE/EACVI SBHF criteria predicted HF with sensitivities of 81% and 55%, specificities of 39% and 76%, and C statistics of 0.60 (95% confidence interval: 0.57, 0.64) and 0.66 (0.61, 0.71), respectively. Adding ARIC DD to SBHF increased sensitivity to 94% with specificity of 24% and C statistic of 0.59 (0.57, 0.61), whereas addition of ASE/EACVI DD to SBHF increased sensitivity to 97% but reduced specificity to 9% and the C statistic to 0.52 (0.50, 0.54, P < 0.0001). Addition of LS to ARIC or ASE/EACVI SBHF criteria had minimal impact on prediction of HF. Conclusions Age‐specific ARIC DD criteria, but not ASE/EACVI DD criteria, predicted symptomatic HF, and addition of age‐specific ARIC DD criteria to ARIC SBHF criteria improved prediction of symptomatic HF in asymptomatic individuals with cardiovascular disease risk factors. Addition of LS to ASE/EACVI or ARIC SBHF criteria did not improve prediction of symptomatic HF.

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Section: Discussioncontrasting

confidence: 97%

Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Age‐specific diastolic dysfunction improves prediction of symptomatic heart failure by Stage B heart failure

et al. 2019

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Echocardiography improves prediction of major adverse cardiovascular events in a population with type 1 diabetes and without known heart disease: the Thousand & 1 Study

et al. 2019

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Aims/hypothesis Cardiovascular disease is the most common comorbidity in type 1 diabetes. However, current guidelines do not include routine assessment of myocardial function. We investigated whether echocardiography provides incremental prognostic information in individuals with type 1 diabetes without known heart disease. Methods A prospective cohort of individuals with type 1 diabetes without known heart disease was recruited from the outpatient clinic. Follow-up was performed through Danish national registers. The association of echocardiography with major adverse cardiovascular events (MACE) and the incremental prognostic value when added to the clinical Steno T1D Risk Engine were examined. Results A total of 1093 individuals were included: median (interquartile range) age 50.2 (39.2-60.3) years and HbA 1c 65 (56-74) mmol/mol; 53% men; and mean (SD) BMI 25.5 (3.9) kg/m 2 and diabetes duration 25.8 (14.6) years. During 7.5 years of followup, 145 (13.3%) experienced MACE. Echocardiography significantly and independently predicted MACE: left ventricular ejection fraction (LVEF) <45% (n = 18) vs ≥45% (n = 1075), HR (95% CI) 3.93 (1.91, 8.08), p < 0.001; impaired global longitudinal strain (GLS), 1.65 (1.17, 2.34) (n = 263), p = 0.005; diastolic mitral early velocity (E)/early diastolic tissue Doppler velocity (e′) <8 (n = 723) vs E/e′ 8-12 (n = 285), 1.59 (1.04, 2.42), p = 0.031; and E/e′ <8 vs E/e′ ≥12 (n = 85), 2.30 (1.33, 3.97), p = 0.003. In individuals with preserved LVEF (n = 1075), estimates for impaired GLS were 1.49 (1.04, 2.15), p = 0.032; E/e′ <8 vs E/e′ 8-12, 1.61 (1.04, 2.49), p = 0.033; and E/e′ <8 vs E/e′ ≥12, 2.49 (1.41, 4.37), p = 0.001. Adding echocardiographic variables to the Steno T1D Risk Engine significantly improved risk prediction: Harrell's C statistic, 0.791 (0.757, 0.824) vs 0.780 (0.746, 0.815), p = 0.027; and net reclassification index, 52%, p < 0.001. Conclusions/interpretation In individuals with type 1 diabetes without known heart disease, echocardiography significantly improves risk prediction over and above guideline-recommended clinical risk factors alone and could have a role in clinical care.

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Epidemiology of heart failure in diabetes: a disease in disguise

Hoek,

Dal Canto,

Wenker

et al. 2024

Diabetologia

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Left ventricular diastolic dysfunction (LVDD) without symptoms, and heart failure (HF) with preserved ejection fraction (HFpEF) represent the most common phenotypes of HF in individuals with type 2 diabetes mellitus, and are more common than HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF) and left ventricular systolic dysfunction (LVSD) in these individuals. However, diagnostic criteria for HF have changed over the years, resulting in heterogeneity in the prevalence/incidence rates reported in different studies. We aimed to give an overview of the diagnosis and epidemiology of HF in type 2 diabetes, using both a narrative and systematic review approach; we focus narratively on diagnosing (using the 2021 European Society of Cardiology [ESC] guidelines) and screening for HF in type 2 diabetes. We performed an updated (2016–October 2022) systematic review and meta-analysis of studies reporting the prevalence and incidence of HF subtypes in adults ≥18 years with type 2 diabetes, using echocardiographic data. Embase and MEDLINE databases were searched and data were assessed using random-effects meta-analyses, with findings presented as forest plots. From the 5015 studies found, 209 were screened using the full-text article. In total, 57 studies were included, together with 29 studies that were identified in a prior meta-analysis; these studies reported on the prevalence of LVSD (n=25 studies, 24,460 individuals), LVDD (n=65 studies, 25,729 individuals), HFrEF (n=4 studies, 4090 individuals), HFmrEF (n=2 studies, 2442 individuals) and/or HFpEF (n=8 studies, 5292 individuals), and on HF incidence (n=7 studies, 17,935 individuals). Using Hoy et al’s risk-of-bias tool, we found that the studies included generally had a high risk of bias. They showed a prevalence of 43% (95% CI 37%, 50%) for LVDD, 17% (95% CI 7%, 35%) for HFpEF, 6% (95% CI 3%, 10%) for LVSD, 7% (95% CI 3%, 15%) for HFrEF, and 12% (95% CI 7%, 22%) for HFmrEF. For LVDD, grade I was found to be most prevalent. Additionally, we reported a higher incidence rate of HFpEF (7% [95% CI 4%, 11%]) than HFrEF 4% [95% CI 3%, 7%]). The evidence is limited by the heterogeneity of the diagnostic criteria over the years. The systematic section of this review provides new insights on the prevalence/incidence of HF in type 2 diabetes, unveiling a large pre-clinical target group with LVDD/HFpEF in which disease progression could be halted by early recognition and treatment.Registration PROSPERO ID CRD42022368035. Graphical Abstract

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Diagnosis of Nonischemic Stage B Heart Failure in Type 2 Diabetes Mellitus

Abstract: Subclinical left ventricular systolic dysfunction is prevalent in asymptomatic elderly patients with type 2 diabetes mellitus, and impaired GLS is independent and incremental to LVH in the prediction of incident HF.

Cited by 62 publications

References 30 publications

Age‐specific diastolic dysfunction improves prediction of symptomatic heart failure by Stage B heart failure

Age‐specific diastolic dysfunction improves prediction of symptomatic heart failure by Stage B heart failure

Echocardiography improves prediction of major adverse cardiovascular events in a population with type 1 diabetes and without known heart disease: the Thousand & 1 Study

Epidemiology of heart failure in diabetes: a disease in disguise

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