An echocardiographic substrate for dyspnea identifies high risk patients with type 2 diabetes. (15th August 2019)

• Record Type: Journal Article
• Authors: Jørgensen, Peter G.; Schou, Morten; Biering-Sørensen, Tor; Mogelvang, Rasmus; Fritz-Hansen, Thomas; Vilsbøll, Tina; Rossing, Peter; Jensen, Magnus T.
• Is Part Of: International journal of cardiology. Volume 289(2019)
• Page Start: 119
• Page End: 124
• Publication Date: 2019-08-15
• Subjects: Echocardiography -- Type 2 diabetes -- Heart failure with preserved ejection fraction; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.04.093
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Dyspnea is a common clinical challenge in patients with type 2 diabetes and may be a sign of heart failure (HF). We sought to evaluate the predictive value dyspnea with and without an echocardiographic substrate in patients with type 2 diabetes without known heart disease. Methods: A total of 724 patients with type 2 diabetes followed at specialized clinics participated in this prospective cohort study. Clinical evaluation, comprehensive echocardiography and follow-up through national registers were performed. An echocardiographic substrate was either left ventricular hypertrophy, increased left atrial size, E/e' > 15, or LV ejection fraction<50%. The end-points were cardiovascular (CVD) events and all-cause mortality. Results: Median follow-up was 4.8 years [Interquartile range: 4.1, 5.3] for CVD event and 77 patients suffered a CVD event. Dyspnea was significantly associated with CVD event: Hazard ratio (HR): 1.58 (95% confidence interval: 1.01–2.48), p = 0.04. Stratifying by evidence of echocardiographic substrate revealed high risk individuals: CVD event: 0.71 (0.35–1.46), p = NS in patients with dyspnea and no echocardiographic substrate and 2.85 (1.74–4.67), p < 0.001 in patients with dyspnea with echocardiographic substrate ). This pattern was similar in multivariable analyses. Also, C-statistics improved from 0.66 (0.60–0.72) to 0.69 (0.63–0.75), p < 0.001 and net reclassification index was 27.5%(5.0–50.0), p = 0.01 for CVD event. The results were similar for all-cause mortality except dyspnea was only a borderline significant predictor. Conclusion: In patients with type 2 diabetes complaining of dyspnea, identifying an echocardiographic substrate - thus indicating patients with HF - accurately stratifies patients with increased risk of CV events and all-cause mortality. Highlights: Dyspnea is common and difficult to assess in patients with type 2 diabetes. Dyspnea was associated with an increased risk of cardiovascular events. An echocardiographic substrate for dyspnea identified high risk patients. No echocardiographic substrate for dyspnea identified low risk patients. Echocardiography is pivotal in patients with type 2 diabetes complaining of dyspnea.