title: The development and feasibility of a composite score of echocardiographic indices that may stratify outcome in patients with diabetes mellitus.
abstract: BACKGROUND
  Early 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.
  
  
  METHODS
  Standard 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.
  
  
  RESULTS
  The 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).
  
  
  CONCLUSIONS
  We 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.
authors.affiliation: Department of Medicine and National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland New Zealand; Department of Statistics, University of Auckland, Private Bag 92019, Auckland, New Zealand. Electronic address: k.poppe@auckland.ac.nz.
authors.forename: Katrina K
authors.initials: KK
authors.lastname: Poppe
authors.affiliation: Faculty of Social and Health Sciences, Unitec Institute of Technology, Private Bag 92025, Auckland, New Zealand.
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Whalley
authors.affiliation: Department of Medicine and National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland New Zealand.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Doughty
authors.affiliation: The George Institute for Global Health, Level 13, 321 Kent Street, Sydney NSW 2000, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: The George Institute for Global Health, Level 13, 321 Kent Street, Sydney NSW 2000, Australia.
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
authors.affiliation: The George Institute for Global Health, Level 13, 321 Kent Street, Sydney NSW 2000, Australia; Westmead Hospital, University of Sydney, NSW 2006, Australia.
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
authors.affiliation: The George Institute for Global Health, Level 13, 321 Kent Street, Sydney NSW 2000, Australia.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Hirakawa
authors.affiliation: The George Institute for Global Health, Level 13, 321 Kent Street, Sydney NSW 2000, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: The George Institute for Global Health, Level 13, 321 Kent Street, Sydney NSW 2000, Australia.
authors.forename: Graham S
authors.initials: GS
authors.lastname: Hillis
authors.affiliation: Department of Statistics, University of Auckland, Private Bag 92019, Auckland, New Zealand.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Triggs
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000000981:diagnostic imaging; D004452:Echocardiography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology
keywords: Diabetes mellitus; Echocardiography; Score