title: The development of heart failure in patients with diabetes mellitus and pre-clinical diastolic dysfunction a population-based study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the outcomes of pre-clinical diastolic dysfunction in diabetic patients.
  
  
  BACKGROUND
  Studies have reported a high prevalence of pre-clinical diastolic dysfunction among patients with diabetes mellitus.
  
  
  METHODS
  We identified all diabetic patients with a tissue Doppler imaging assessment of diastolic function in Olmsted County, Minnesota, from 2001 to 2007. Diastolic dysfunction was defined as a passive transmitral left ventricular (LV) inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (E/e') ratio >15. The main outcome was the development of heart failure (HF). Secondary outcomes were the development of atrial fibrillation and death.
  
  
  RESULTS
  Overall, 1,760 diabetic patients with a tissue Doppler echocardiographic assessment of diastolic function were identified; 411 (23%) patients had diastolic dysfunction. Using multivariable Cox's proportional hazard modeling, we determined that for every 1-U increase in the passive transmitral LV inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (E/e') ratio, the hazard ratio (HR) of HF increased by 3% (HR: 1.03; 95% confidence interval [CI]: 1.01 to 1.06; p = 0.006) and that diastolic dysfunction was associated with the subsequent development of HF after adjustment for age, sex, body mass index, hypertension, coronary disease, and echocardiographic parameters (HR: 1.61; 95% CI: 1.17 to 2.20; p = 0.003). The cumulative probability of the development of HF at 5 years for diabetic patients with diastolic dysfunction was 36.9% compared with 16.8% for patients without diastolic dysfunction (p < 0.001). Furthermore, diabetic patients with diastolic dysfunction had a significantly higher mortality rate compared with those without diastolic dysfunction.
  
  
  CONCLUSIONS
  We demonstrated that an increase in the passive transmitral LV inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (E/e') ratio in diabetic patients is associated with the subsequent development of HF and increased mortality independent of hypertension, coronary disease, or other echocardiographic parameters.
authors.affiliation: Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: From
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Scott
authors.forename: Horng H
authors.initials: HH
authors.lastname: Chen
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology; D048909:Diabetes Complications / Q000401:mortality / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D054144:Heart Failure, Diastolic / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left