Abstract
BackgroundSubclinical left ventricular (LV) diastolic dysfunction in type 2 diabetes (T2D) is a common finding and represents an early sign of diabetic cardiomyopathy. However, the relationship between LV diastolic dysfunction and the incident T2D has not been previously studied.MethodsA total of 1817 non-diabetic participants (mean age, 54 years; 48% men) from the Korean Genome and Epidemiology Study who were free of cardiovascular disease were studied. LV structure and function were assessed by conventional echocardiography and tissue Doppler imaging. Subclinical LV diastolic dysfunction was defined using age-specific cutoff limits for early diastolic (Em) velocity, mitral E/Em ratio, and left atrial volume index.ResultsDuring the 6-year follow-up period, 273 participants (15%) developed T2D. Participants with incident T2D had greater LV mass index (86.7 ± 16.4 vs. 91.2 ± 17.0 g/m2), worse diastolic function, reflected by lower Em velocity (7.67 ± 1.80 vs. 7.47 ± 1.70) and higher E/Em ratio (9.19 ± 2.55 vs. 10.23 ± 3.00), and higher prevalence of LV diastolic dysfunction (34.6 vs. 54.2%), compared with those who did not develop T2D (all P < 0.001). In a multivariate logistic regression model, lower Em velocity (odd ratio [OR], 0.867; 95% confidence interval [CI] 0.786–0.957) and the presence of LV diastolic dysfunction (OR, 1.617; 95% CI 1.191–2.196) were associated with the development of T2D, after adjusting for potential confounding factors.ConclusionsIn a community-based cohort, the presence of subclinical LV diastolic dysfunction was a predictor of the progression to T2D. These data suggest that the echocardiographic assessment of LV diastolic function may be helpful in identifying non-diabetic subjects at risk of incident T2D.
Highlights
Subclinical left ventricular (LV) diastolic dysfunction in type 2 diabetes (T2D) is a common finding and represents an early sign of diabetic cardiomyopathy
Recent advances in cardiovascular imaging technology have facilitated the detection of underlying subclinical target organ damage, which is useful for both the prediction of future cardiovascular disease (CVD) and risk
Among the 1817 subjects without known CVD, 788 (43.4%) participants had normal glucose metabolism (NGM) and 1029 (56.6%) had prediabetes at baseline according to ADA recommendations
Summary
Subclinical left ventricular (LV) diastolic dysfunction in type 2 diabetes (T2D) is a common finding and represents an early sign of diabetic cardiomyopathy. In a recent study, the presence of subclinical target organ damage, including LV hypertrophy and carotid atherosclerosis, was shown to be a significant predictor of the development of new onset diabetes in hypertensive patients, independent of traditional CV risk factors [2]. It is still unclear whether the presence of asymptomatic target organ damage could help to identify sub-populations of nondiabetic individuals who are at increased risk of incident T2D. The present analysis was designed to evaluate the prospective relation between the presence of baseline LV diastolic dysfunction and the development of T2D in the general population
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