The development and feasibility of a composite score of echocardiographic indices that may stratify outcome in patients with diabetes mellitus

Abstract

BackgroundEarly detection of changes in cardiac structure and function associated with type 2 diabetes (T2DM) is important. However when multiple abnormalities are present, combining individual measurements can be subjective. This study sought to create a simple echo score that summarises measurements that may detect early and prognostically important changes in cardiac function. MethodsStandard echocardiography was performed on 849 people with T2DM (median age 65years, 40% female, median duration of diabetes 5.5years). Principal components analysis was performed on measurements of LV mass, LA volume, E:e′, and s′, to create an objective summary score. The score was included in two Cox proportional hazard models adjusted for CV risk factors: one estimated the development of heart failure (HF) and the second estimated any CV event. ResultsThe first two principal components represented 75% of the variation between the four echo measurements. A continuous score that represents the residual difference between these two components was derived that only requires measurement of medial E:e′ and s′. The score was significantly associated with the development of HF within four years (hazard ratio 1.34; 95% CI 1.15, 1.56). ConclusionsWe have developed a simple, objective score that enhances the use of echocardiography in the detection of sub-clinical cardiac disease in people with T2DM. Initial findings suggest that it may help identify those at increased risk of developing HF within four years.