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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
Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. City Hospital Ryhov, Jönköping, Sweden.
Linköping University.
Linköping University.
Linköping University.
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2015 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 16, no 9, p. 1000-1007Article in journal (Refereed) Published
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Abstract [en]

Aims: The aim of the study was to determine whether left ventricular systolic function, in terms of global left ventricular longitudinal strain (GLS), and diastolic function, expressed as the ratio between early diastolic transmitral flow and mitral annular motion velocities (E/e'), can predict cardiovascular events in patients with diabetes mellitus type 2.

Methods and results: We prospectively investigated 406 consecutive patients, aged 55-65 years, with diabetes mellitus, who participated in the CARDIPP study. Echocardiography, pulse pressure (pp), and glycosylated haemoglobin (HbA1c) were analysed. Twelve cases of myocardial infarction and seven cases of stroke were identified during the follow-up period of 67 +/- 17 months. Univariate Cox regression analysis showed that E/e' was a strong predictor of cardiovascular events (hazards ratio 1.12; 95% confidence interval 1.06-1.18, P < 0.001). E/e' was prospectively associated with cardiovascular events independent of age, sex, GLS, left ventricular ejection fraction (LVEF), pp, and HbA1c in multivariate analysis. Receiver operating characteristic curves showed that E/e' and HbA1c were the strongest predictors for cardiovascular events, both having an area under the curve (AUC) of 0.71 followed by LVEF with an AUC of 0.65 and GLS of 0.61. In a Kaplan-Meyer analysis, the cumulative probability of an event during the follow-up period was 8.6% for patients with an E/e' ratio >15 compared with 2.6% for patients with E/e' <= 15, P = 0.011.

Conclusion: 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.

Place, publisher, year, edition, pages
2015. Vol. 16, no 9, p. 1000-1007
Keywords [en]
echocardiography, global left ventricular longitudinal strain, diastolic dysfunction, diabetes mellitus, myocardial infarction, stroke
National Category
Cardiac and Cardiovascular Systems
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URN: urn:nbn:se:hj:diva-28549DOI: 10.1093/ehjci/jev027ISI: 000364539700011PubMedID: 25750201Scopus ID: 2-s2.0-84989196033OAI: oai:DiVA.org:hj-28549DiVA, id: diva2:881440
Available from: 2015-12-10 Created: 2015-12-10 Last updated: 2017-12-01Bibliographically approved

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