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Diagnosis of nonischemic stage B heart failure in type 2 diabetes mellitus: optimal parameters for prediction of heart failure

Wang, Y ORCID: 0000-0002-7274-8427, Yang, H, Huynh, Q ORCID: 0000-0003-1368-5160, Nolan, MT, Negishi, K ORCID: 0000-0002-9086-2565 and Marwick, TH ORCID: 0000-0001-9065-0899 2018 , 'Diagnosis of nonischemic stage B heart failure in type 2 diabetes mellitus: optimal parameters for prediction of heart failure' , JACC: Cardiovascular Imaging, no. May , pp. 1-11 , doi: 10.1016/j.jcmg.2018.03.015.

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Objectives: This study sought to identify whether impaired global longitudinal strain (GLS), diastolic dysfunction (DD), or left atrial enlargement (LAE) should be added to stage B heart failure (SBHF) criteria in asymptomatic patients with type 2 diabetes mellitus.Background: SBHF is a precursor to clinical heart failure (HF), and its recognition justifies initiation of cardioprotective therapy. However, original definitions of SBHF were based on LV hypertrophy and impaired ejection fraction.Methods: Patients with asymptomatic type 2 diabetes mellitus ≥65 years-of-age (age 71 ± 4 years; 55% men) with preserved ejection fraction and no ischemic heart disease were recruited from a community-based population. All underwent a standard clinical evaluation, and a comprehensive echocardiogram, including assessment of left ventricular hypertrophy (LVH), LAE, DD (abnormal E/e'), and GLS (Results: In this asymptomatic group, LV dysfunction was identified in 30 (10%) by DD, 68 (23%) by LVH, 102 (35%) by LAE, and 68 (23%) by impaired GLS. New-onset HF developed in 45 patients and 4 died, giving an event rate of 112/1,000 person-years. Survival free of the composite endpoint (HF and death) was about 1.5-fold higher in patients without a normal, compared with an abnormal echocardiogram. LVH, LAE, and GLS Conclusions: 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.

Item Type: Article
Authors/Creators:Wang, Y and Yang, H and Huynh, Q and Nolan, MT and Negishi, K and Marwick, TH
Keywords: T2DM, community, echocardiography, global longitudinal strain, stage B heart failure, subclinical LV dysfunction
Journal or Publication Title: JACC: Cardiovascular Imaging
Publisher: Elsevier Inc.
ISSN: 1936-878X
DOI / ID Number: 10.1016/j.jcmg.2018.03.015
Copyright Information:

© 2018 by the American College of Cardiology Foundation.

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