Strategy to identify subjects with diabetes mellitus more suitable for selective echocardiographic screening: The DAVID-Berg study. (1st December 2017)

• Record Type: Journal Article
• Authors: Gori, Mauro; Canova, Paolo; Calabrese, Alice; Cioffi, Giovanni; Trevisan, Roberto; De Maria, Renata; Grosu, Aurelia; Iacovoni, Attilio; Fontana, Alessandra; Ferrari, Paola; Greene, Stephen J.; Gheorghiade, Mihai; Parati, Gianfranco; Gavazzi, Antonello; Senni, Michele
• Is Part Of: International journal of cardiology. Volume 248(2017)
• Page Start: 414
• Page End: 420
• Publication Date: 2017-12-01
• Subjects: Echocardiographic screening -- NTproBNP -- Electrocardiogram -- Long term follow-up -- Heart failure; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.06.101
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Despite the burden of pre-clinical heart failure (HF) among diabetes mellitus (DM) patients, routine screening echocardiography is not currently recommended. We prospectively assessed risk prediction for HF/death of a screening strategy combining clinical data, electrocardiogram, NTproBNP, and echocardiogram, aiming to identify DM patients more suitable for selective echocardiography. Methods: Among 4047 screened subjects aged ≥ 55/≤80 years, the DAVID-Berg Study prospectively enrolled 623 outpatients with DM, or hypertension, or known cardiovascular disease but with no HF history/symptoms. The present analysis focuses on data obtained during a longitudinal follow-up of the 219 patients with DM. Results: Mean age was 68 years, 61% were men, and median DM duration was 4.9 years. During a median follow-up of 5.2 years, 50 subjects developed HF or died. A predictive model using clinical data demonstrated moderate predictive power, which significantly improved by adding electrocardiogram (C-statistic 0.75 versus 0.70; p < 0.05), but not NTproBNP (C-statistic 0.72, p = 0.20). Subjects with normal clinical variables or abnormal clinical variables but normal electrocardiogram had low events rate (1.3 versus 2.4 events/100-person-years, p = NS). Conversely, subjects with both clinical and electrocardiogram abnormalities (47%) carried higher risk (9.0 events/100-person-years, p < 0.001). The predictive power for mortality/HF development increased when echocardiography was added (13.6 events/100-person-years, C-statistic 0.80, p < 0.05). Conclusions: Our prospective study found that a selective echocardiographic screening strategy guided by abnormal clinical/electrocardiogram data can reliably identify DM subjects at higher risk for incident HF and death. This screening approach may hold promise in guiding HF prevention efforts among DM patients.