Left ventricular diastolic function, assessed by echocardiography and tissue Doppler imaging, is a strong predictor of cardiovascular events, superior to global left ventricular longitudinal strain, in patients with type 2 diabetes

Blomstrand, Peter; Engvall, Martin; Festin, Karin; Lindström, Torbjörn; Länne, Toste; Maret, Eva; Nyström, Fredrik; Maret-Ouda, John; Östgren, Carl Johan; Engvall, Jan

doi:10.1093/ehjci/jev027

Cited by 37 publications

(45 citation statements)

References 45 publications

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“…The lower e', as well as the higher E/e' ratio, in patients with diabetes reflected the impaired left ventricular diastolic function. According to the Cardiovascular Risk factors in Patients with Diabetesa Prospective study in Primary care study, the E/e' ratio in middle-aged patients with type 2 diabetes was a strong predictor for cardiovascular events 16 In patients with diabetes, the percentage of aortic root diameter dilatation was significantly lower, when compared with those without diabetes. The difference was more obvious in men (43.59 vs 21.21% in men, 29.87 vs 20.00% in women, P < 0.05).…”

Section: Discussionmentioning

confidence: 99%

“…The lower e ’, as well as the higher E / e ’ ratio, in patients with diabetes reflected the impaired left ventricular diastolic function. According to the Cardiovascular Risk factors in Patients with Diabetes – a Prospective study in Primary care study, the E / e ’ ratio in middle‐aged patients with type 2 diabetes was a strong predictor for cardiovascular events. When adjusted for age, sex and other clinical confounders, diabetes remained to be an independent correlate of aortic root dilatation in ESRD patients.…”

Section: Discussionmentioning

confidence: 99%

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Diabetes attenuated age‐related aortic root dilatation in end‐stage renal disease patients receiving peritoneal dialysis

Zhang

et al. 2019

J of Diabetes Invest

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Aims/Introduction Recently, some data have supported the concept that diabetes is negatively associated with aortic aneurysm. In the present study, we aimed to investigate the relationship between diabetes and cardiac structural and functional characteristics, in particular, aortic root dimensions, in end‐stage renal disease (ESRD) patients. Methods ESRD patients receiving peritoneal dialysis for >3 months were consecutively enrolled. Clinical features and echocardiographic parameters were analyzed according to the presence of diabetes history. Correlation analyses were carried out for diabetes mellitus and aortic root dilatation. Multiple logistic regression analysis was carried out to identify variables correlated with aortic root dilatation. Results A total of 218 ESRD patients receiving peritoneal dialysis were enrolled. Patients with diabetes showed lower left ventricular internal measurements in end‐diastole, left ventricular internal measurements in end‐systole and aortic root diameter (ARD)/body surface area (BSA). Worse cardiac diastolic function was also observed in these patients. In addition, the age‐related increase of ARD/BSA and ARD/height was attenuated in patients with diabetes. With the increase of ARD/BSA, lower levels of serum creatinine, phosphorus and serum glucose, as well as higher serum high‐density lipoprotein cholesterol and apolipoprotein A‐1 were also observed. Increased normalized left ventricular internal measurements were shown in patients with greater ARD/BSA. Multiple regression analysis showed that diabetes (odds ratio 0.353, P = 0.015) was an independent correlate of aortic root dilatation, even after correction for age, sex and other clinical confounders in the enrolled patients. Conclusions The present findings shown an inverse association between diabetes and age‐related aortic root dilatation in ESRD patients. Diabetes remained to be independently correlated with aortic root dilatation even after adjustment for age, sex and other clinical confounders in ESRD patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diabetes attenuated age‐related aortic root dilatation in end‐stage renal disease patients receiving peritoneal dialysis

Zhang

et al. 2019

J of Diabetes Invest

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“…A large LA volume index has been reported in echocardiographic studies in asymptomatic diabetics, as in nondiabetics, to relate to adverse cardiac outcomes [14,15,16,17,18,19]. The CTA LA volume, normalized to the RA volume rather than to body surface area, has not been reported previously as a predictor of HF.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent echo-Doppler-based study in type 2 diabetics, measures of LV diastolic dysfunction correlated with CV outcomes but HF was not examined [19]. HF may be associated with diabetic cardiomyopathy, which is diagnosed in the presence of impaired glucose metabolism with systolic or diastolic LV dysfunction in the absence of other causes, commonly hypertension and CAD [22].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study

Halon¹,

Jubran²,

Rubinshtein³

et al. 2017

Cardiology

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Objectives: Predictive models for heart failure (HF) in heterogeneous populations have had limited success. We examined cardiac computed tomography angiography (CTA) predictors of HF or cardiovascular death (HF-CVD) in a prospective study of asymptomatic diabetics undergoing baseline assessment by CTA. Methods: The subjects (n = 735, aged 55-74 years, 51.2% women) had no clinical history of cardiovascular disease at study entry. Coronary artery calcium (CAC) score, CTA-defined coronary atherosclerosis, cardiac chamber volumes, and clinical data were collected and late outcome events recorded over 8.4 ± 0.6 years (range 7.3-9.3). Results: HF-CVD occurred in 41 (5.6%) subjects, with HF occurring mostly (19/23, 82.6%) in subjects without preceding myocardial infarction. Baseline univariate clinical outcome predictors of HF-CVD included older age (p = 0.027), the duration of diabetes (p = 0.004), HbA1c (p < 0.0001), microvascular disease (retinopathy, microalbuminuria) (p < 0.0001), and systolic blood pressure (p = 0.035). Baseline univariate CTA predictors included CAC score (p = 0.004), coronary stenosis (p = 0.047), and a CTA-defined left/right atrial (LA/RA) volume ratio >1 (p < 0.0001). Independent predictors were an LA/RA volume ratio >1, microvascular disease, and systolic blood pressure (model C-statistic 0.792, 95% CI 0.758-0.824). Measures of the extent of coronary artery disease (CAD) were not independent predictors of HF-CVD. Conclusions: In a low- to moderate-risk asymptomatic diabetic population, CTA LA enlargement (LA/RA volume ratio) but not the extent of CAD had independent prognostic value for HF-CVD in addition to the clinical variables.

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“…Furthermore, the diastolic function and measurements thereof are affected by age, hypertension, ischaemic heart disease and even diabetes (41), all commonly coexisting with sepsis. The interpretation of diastolic dysfunction is therefore, for a number of reasons, complicated in intensive care patients.…”

Section: Left Ventricular Diastolic Functionmentioning

confidence: 99%

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Geer

2016

Linköping University Medical Dissertations

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Background: Cardiac dysfunction is a well-known complication of sepsis, but its characteristics and consequences, especially on a longer term, remain unclear. The aim of this thesis was to study the characteristics and the implications of cardiac dysfunction for outcome in intensive care unit (ICU) patients with septic shock. Purpose: First, to assess the ability of a cardiac biomarker to predict outcome in ICU patients. Second, to characterise cardiac dysfunction in septic shock using speckle tracking echocardiography. Third, to investigate the reliability of echocardiographic methods used to describe cardiac dysfunction in septic shock. Fourth, to study long-term cardiac outcome in severe sepsis and septic shock patients. Materials and methods: The cardiac biomarker amino-terminal pro-brain natriuretic peptide (NTproBNP) was collected in 481 patients on ICU admission and its ability to predict death was assessed. In 50 patients with septic shock, echocardiography was performed on ICU admission and was repeated during and after ICU stay. Measurements of cardiac strain using speckle tracking echocardiography were assessed in relation to other echocardiographic function parameters, NT-proBNP and severity of illness scores, and their change over time was analysed. Echocardiograms from patients with septic shock were independently evaluated by two physicians and the results analysed regarding measurement variability. A nationwide-registry-based open cohort of 9,520 severe sepsis and septic shock ICU patients discharged alive from the ICU was analysed together with a non-septic control group matched for age, sex and severity of illness. In patients who died after ICU discharge, information on causes of death was collected. Results: A discriminatory level of significance of NT-proBNP on ICU admission was identified at ≥1,380 ng/L, above which NT-proBNP was an independent predictor of death. With increasing levels of NT-proBNP, patients were more severely ill, had a longer ICU stay and were more often admitted with septic shock. Cardiac strain was frequently impaired in septic shock patients but was not superior to other echocardiographic measurements in detecting cardiac dysfunction. Cardiac strain correlated with other echocardiographic function parameters and with NT-proBNP, and was the least user-dependent echocardiographic parameter in septic shock patients. Cardiac strain remained unchanged over time, did not differ between survivors and non-survivors and could not predict an increased risk of death. During a follow-up of up to nearly 6 years after ICU discharge, 3,954 (42%) of sepsis patients died, 654 (17%) with cardiac failure as the cause of death. With increasing severity of illness on admission, the risk of death with cardiac failure as the cause of death after ICU discharge increased. In comparison to other ICU patients with similar severity of illness, however, the risk of death due to cardiac was not increased in patients with severe sepsis or septic shock. Conclusions: Laboratory or echocardiographic si...

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Left ventricular diastolic function, assessed by echocardiography and tissue Doppler imaging, is a strong predictor of cardiovascular events, superior to global left ventricular longitudinal strain, in patients with type 2 diabetes

Abstract: In middle-aged patients with type 2 diabetes, E/e' is a strong predictor of myocardial infarction and stroke, comparable with HbA1c and superior to GLS and LVEF.

Cited by 37 publications

References 45 publications

Diabetes attenuated age‐related aortic root dilatation in end‐stage renal disease patients receiving peritoneal dialysis

Diabetes attenuated age‐related aortic root dilatation in end‐stage renal disease patients receiving peritoneal dialysis

Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

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