title: Competing risks of heart failure with preserved ejection fraction in diabetic patients.
abstract: OBJECTIVE
  The prevalence of heart failure with preserved ejection fraction (HFpEF) has increased in the past two decades, and diabetes mellitus (DM) is frequently associated with HFpEF. Although it has been demonstrated that left ventricular (LV) diastolic and vascular functional abnormalities are generally observed in HFpEF, it remains to be clinically elucidated how an asymptomatic stage progresses to symptomatic HFpEF in DM patients. We aimed to identify risk factors associated with incident HFpEF in DM patients and to evaluate the contribution of LV relaxation and compliance to the development of HFpEF.
  
  
  RESULTS
  The study included 544 consecutive Japanese DM patients with ejection fraction ≥50%. Patients with coronary artery disease or serum creatinine ≥2.0 mg/dL were excluded. Multiple logistic regression analysis revealed that obesity, female gender, anaemia, and impaired LV compliance were independently associated with the prevalence of HFpEF, and that age, LV mass index, an index of LV relaxation, estimated glomerular filtration rate, and history of hypertension were not. There was no difference in haemoglobin A1c or brachial-ankle pulse wave velocity between the DM patients with and without HFpEF.
  
  
  CONCLUSIONS
  This study suggests that exacerbation of LV compliance impairment, rather than of relaxation abnormality or vascular stiffening, plays a crucial role in the induction of HFpEF in DM patients regardless of the severity of DM and renal dysfunction. Anaemia and obesity may also contribute to the transition from asymptomatic stage to symptomatic HFpEF even without further progression of LV diastolic dysfunction.
authors.affiliation: Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Takeda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Mano
authors.forename: Tomohito
authors.initials: T
authors.lastname: Ohtani
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kamimura
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Tamaki
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Omori
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Tsukamoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Aizawa
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications*