Outcomes of asymptomatic left ventricular dysfunction in the patient with or without type 2 diabetic Mellitus

Abstract

Abstract Background Type 2 diabetes mellitus (T2DM) has been related to ventricular systolic and diastolic dysfunction and subsequent heart failure. [1] The study aimed to investigate the prevalence of asymptomatic left ventricular dysfunction (aLVD) in subjects with T2DM, and its predisposing factors. Method Subjects without existed cardiovascular disease were eligible for this study. Left ventricular ejection fraction (LVEF), mitral E/A ratio, peak mitral annulus tissue velocity (e’), left atrial dimension (LAD), peak tricuspid regurgitation velocity (TR Vmax) were obtained by a standard echocardiographic study. Asymptomatic left ventricular diastolic dysfunction (ALVSD) was defined as LVEF < 50% and the asymptomatic left ventricular diastolic dysfunction (ALVDD) was defined as having three or more of the four parameters: septal e' < 7, septal E/e’>15, LAD > 40mm, and TR Vmax > 2.8 m/s. [2] All-cause mortality up to 2 years was obtained by linking to the National Death Registry. Result A total of 27684 subjects (59.6±17.4 years, 46.2% men, 17.7% diabetes) were included in this study(Table 1). The ALVSD patients were older, male dominant, more prevalent with hypertension, diabetes mellitus and coronary artery disease, and had higher BMI, lower hemoglobin, and estimated glomerular filtration rate. ALVSD and ALVDD was more prevalent in patients with T2DM than those without (4.9% vs 8.2%, P<0.001)(15.4% v.s. 32.1%) (Figure 1). Age (odds ratio and 95% confidence interval: 1.04, 1.03–1.04), male gender(2.24, 1.99-2.52), T2DM (1.28, 1.11-1.46), coronary artery disease (1.38, 1.14-1.68), hemoglobin (0.95, 0.91-1.00), CKD stage 3(2.02, 1.63-2.50), and CKD stage 4-5(3.95, 3.06-5.09) were all independently correlated to ALVSD(Table 2a). On the other hand age (odds ratio and 95% confidence interval: 1.07, 1.07–1.08), BMI (1.12, 1.11-1.13), T2DM (1.34, 1.24-1.46), hypertension (1.31, 1.20-1.43), hemoglobin (0.88, 0.85-0.91), and CKD stage 4-5(3.11, 2.58-3.76) were independently correlated to ALVDD(Table 2b). During a mean follow-up of 5.3 ± 3.6 years, there were 2625 deaths (9.5%). The Kaplan–Meier curve analysis revealed diabetic subjects with were associated with the worst survival rate than those with either T2DM or ALVSD/ALVDD (Figure 2). The Cox regression analysis revealed the ALVDD and ALVSD was related to mortality, independent of age, gender, body mass index, hypertension, coronary artery disease, hemoglobulin, estimated glomerular filtration rate, and medication [hazard ratio and 95% confidence interval of mortality(ALVSD/ALVDD): 1.78 (1.40–2.25)/1.31(1.15-1.49)]. Conclusion ALVD has a high disease burden in patients without established cardiovascular disease, and its prevalence is higher in patients with T2DM, which was associated with an excessive mortality rate. Therefore, early screening and intervention should be considered in diabetic patients.