Abstract
BackgroundPatients with type 2 diabetes mellitus (T2DM) are at high risk for cardiovascular events. The aim of the study was to assess whether global longitudinal strain (GLS) provides prognostic value in these patients.MethodsA total of 247 T2DM patients without history of cardiovascular complications and participated in the CDATS study were prospectively enrolled. Left ventricular (LV) systolic function was assessed by LV ejection fraction and speckle tracking derived LV systolic GLS. Diastolic function was assessed by E/E′ ratio defined as the passive trans-mitral LV inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus. Cardiovascular event included acute coronary syndrome, cerebrovascular stroke, hospitalization for heart failure and cardiovascular death.ResultsA total of 18 cardiovascular events occurred during a median follow-up duration of 33 months. Both E/E′ ratio [hazard ratio (HR) 1.15, P < 0.01] and GLS (HR 1.39, P < 0.01) were independently associated with cardiovascular events. Importantly, GLS provided incremental prognostic information in addition to clinical data, HbA1c and E/E′ ratio (Chi square 77.46, P = 0.04). Receiver-operator characteristic curve analysis demonstrated that E/E′ ratio [area under curve (AUC) 0.66, P = 0.03] and GLS (AUC 0.72, P < 0.01) were strong predictors of cardiovascular events. Kaplan–Meier analysis showed that patients with E/E′ > 13.6 or GLS > −17.9 % were associated with cardiovascular events. The presence of either a high E/E′ ratio or an impaired GLS provides an excellent negative predictive value of cardiovascular events in these patients.ConclusionsIn T2DM patients with no history of cardiovascular disease, impaired GLS was associated with cardiovascular events and provided incremental prognostic value.
Highlights
Patients with type 2 diabetes mellitus (T2DM) are at high risk for cardiovascular events
The aim of the present study was to assess the incremental prognostic value of systolic global longitudinal strain (GLS) to predict for cardiovascular events in T2DM patients with no history of cardiovascular complication in addition to clinical data, HbA1c level and diastolic dysfunction
A total of 18 cardiovascular events were recorded during a median follow-up duration of 33 months; 7 patients diagnosed with acute coronary syndrome (ACS), 3 patients with hospitalizations for heart failure, 6 patients with cerebrovascular stroke and 2 cardiovascular deaths due to refractory heart failure
Summary
Patients with type 2 diabetes mellitus (T2DM) are at high risk for cardiovascular events. The aim of the study was to assess whether global longitudinal strain (GLS) provides prognostic value in these patients. Prior studies have demonstrated that clinical demographics and HbA1c level can help identify patients with T2DM at high risk for cardiovascular events [3, 4]. The presence of diastolic dysfunction detected by conventional echocardiography has been shown to help risk stratification in these patients [5, 6]. The aim of the present study was to assess the incremental prognostic value of systolic GLS to predict for cardiovascular events in T2DM patients with no history of cardiovascular complication in addition to clinical data, HbA1c level and diastolic dysfunction
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