title: Impact of left ventricular longitudinal diastolic functional reserve on clinical outcome in patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  Left ventricular longitudinal diastolic functional reserve (DFR), as assessed by the change in early diastolic mitral annular velocity (E') during exercise, is abnormal in patients with type 2 diabetes mellitus (DM). However, the impact of left ventricular longitudinal DFR on clinical outcome has not been explored. This study evaluated the incremental prognostic value of left ventricular DFR in patients with type 2 DM without overt heart disease.
  
  
  METHODS
  Of 1485 patients who were referred for exercise stress echocardiography, 197 consecutive patients (mean age, 58 years; 84 men) with type 2 DM without overt heart disease were identified. Left ventricular longitudinal DFR was defined as the change in E' from resting to exercise (ΔE'). The endpoint was a composite of death and hospitalisation for heart failure (HF).
  
  
  RESULTS
  During a median follow-up of 57 months (range 6-90), 18 of 197 patients (9.1%) had adverse events (12 deaths, six hospitalisations for HF). Independent predictors of adverse events in a Cox regression analysis were estimated glomerular filtration rate (HR 0.97; 95% CI 0.95 to 0.98; p<0.001), DM duration (HR 1.07; 95% CI 1.01 to 1.14; p=0.018) and ΔE' (HR 0.58; 95% CI 0.40 to 0.85; p=0.005). In an incremental model, the addition of stress echo data significantly increased the χ² of the clinical and resting left ventricular function model, from 40.5 to 46.6 (p=0.005).
  
  
  CONCLUSIONS
  Assessment of left ventricular longitudinal DFR during exercise provided incremental prognostic information in patients with type 2 DM without overt heart disease.
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea. jwha@yuhs.ac
authors.forename: Sung-Ai
authors.initials: SA
authors.lastname: Kim
authors.forename: Chi-Young
authors.initials: CY
authors.lastname: Shim
authors.forename: Jin-Mi
authors.initials: JM
authors.lastname: Kim
authors.forename: Hyun-Jin
authors.initials: HJ
authors.lastname: Lee
authors.forename: Dong-Hoon
authors.initials: DH
authors.lastname: Choi
authors.forename: Eui-Young
authors.initials: EY
authors.lastname: Choi
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Namsik
authors.initials: N
authors.lastname: Chung
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Ha
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D003971:Diastole; D025401:Echocardiography, Stress / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*