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

Cardiovascular Diabetology

Research

Julian W. Sacre¹  Leah Wright¹  Jonathan E. Shaw²  Amera Halabi²  Elizabeth Potter²  Thomas H. Marwick³  Hilda Yang⁴ 

[1] (Dept) Imaging Research, Baker Heart and Diabetes Institute, PO Box 6492, 75 Commercial Road, 3004, Melbourne, VIC, Australia;(Dept) Imaging Research, Baker Heart and Diabetes Institute, PO Box 6492, 75 Commercial Road, 3004, Melbourne, VIC, Australia;School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, 3004, Melbourne, VIC, Australia;(Dept) Imaging Research, Baker Heart and Diabetes Institute, PO Box 6492, 75 Commercial Road, 3004, Melbourne, VIC, Australia;School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, 3004, Melbourne, VIC, Australia;(Dept) Imaging Research, Menzies Institute for Medical Research, 17 Liverpool Street, 7000, Hobart, TAS, Australia;(Dept) Imaging Research, Menzies Institute for Medical Research, 17 Liverpool Street, 7000, Hobart, TAS, Australia;

关键词: Diabetes;    LV dysfunction;    Heart failure;    Echocardiography;    Natriuretic peptides;   

DOI  :  10.1186/s12933-022-01711-5

 received in 2022-09-11, accepted in 2022-11-30,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundSubclinical 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.MethodsParticipants 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)).ResultsOf 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.ConclusionAlthough 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.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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Fig. 1