Left ventricular diastolic function, assessed by echocardiography and tissue Doppler imaging, is a strong predictor of cardiovascular events, superior to global left ventricular longitudinal strain, in patients with type 2 diabetes.
OBJECTIVE
The aim of the study was to determine whether left ventricular systolic function, in terms of global left ventricular longitudinal strain (GLS), and diastolic function, expressed as the ratio between early diastolic transmitral flow and mitral annular motion velocities (E/e'), can predict cardiovascular events in patients with diabetes mellitus type 2.


RESULTS
We prospectively investigated 406 consecutive patients, aged 55-65 years, with diabetes mellitus, who participated in the CARDIPP study. Echocardiography, pulse pressure (pp), and glycosylated haemoglobin (HbA1c) were analysed. Twelve cases of myocardial infarction and seven cases of stroke were identified during the follow-up period of 67 ± 17 months. Univariate Cox regression analysis showed that E/e' was a strong predictor of cardiovascular events (hazards ratio 1.12; 95% confidence interval 1.06-1.18, P < 0.001). E/e' was prospectively associated with cardiovascular events independent of age, sex, GLS, left ventricular ejection fraction (LVEF), pp, and HbA1c in multivariate analysis. Receiver operating characteristic curves showed that E/e' and HbA1c were the strongest predictors for cardiovascular events, both having an area under the curve (AUC) of 0.71 followed by LVEF with an AUC of 0.65 and GLS of 0.61. In a Kaplan-Meyer analysis, the cumulative probability of an event during the follow-up period was 8.6% for patients with an E/e' ratio >15 compared with 2.6% for patients with E/e' ≤15, P = 0.011.


CONCLUSIONS
In middle-aged patients with type 2 diabetes, E/e' is a strong predictor of myocardial infarction and stroke, comparable with HbA1c and superior to GLS and LVEF.
Department of Clinical Physiology, County Hospital Ryhov, Jönköping 551 85, Sweden Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University, Högskoleområdet, Jönköping, Sweden Peter.Blomstrand@lj.se.
Peter
P
Blomstrand
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Martin
M
Engvall
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Karin
K
Festin
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Torbjörn
T
Lindström
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Toste
T
Länne
Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
Eva
E
Maret
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Fredrik H
FH
Nyström
Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden.
John
J
Maret-Ouda
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Carl Johan
CJ
Östgren
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Department of Clinical Physiology, Linköping University, Linköping, Sweden Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
Jan
J
Engvall
D000368:Aged; D000704:Analysis of Variance; D019540:Area Under Curve; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D013548:Sweden; D018608:Ultrasonography, Doppler / Q000379:methods; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology
D001786:Blood Glucose
diabetes mellitus; diastolic dysfunction; echocardiography; global left ventricular longitudinal strain; myocardial infarction; stroke