Subclinical LV dysfunction and 10-year outcomes in type 2 diabetes mellitus.
OBJECTIVE
New imaging techniques have permitted the detection of subclinical LV dysfunction (LVD) in up to half of patients with type 2 diabetes mellitus (DM) with a normal EF. However, the connection between early LVD and prognosis is unclear. This study aimed to define the long-term outcome of LVD associated with type 2 DM.


METHODS
In this prospective cohort study, 230 asymptomatic patients with type 2 DM underwent measurement of global longitudinal 2D strain (GLS) for detection of LVD and were followed for up to 10 years. All subjects had normal EF (≥50%) and no evidence of coronary artery disease at recruitment. Outcome data were obtained through centralised state-wide death and hospital admission registries. The primary endpoint was all-cause mortality and hospitalisation.


RESULTS
On study entry, almost half (45%) of the cohort had evidence of LVD as detected by GLS. Over a median follow-up of 7.4±2.6 years (range 0.6-9.7 years), 68 patients (30%) met the primary endpoint (LVD: 37%; normal LV function: 24%). GLS was independently associated with the primary endpoint (HR=1.10; p=0.04), as was systolic blood pressure (HR=1.02; p<0.001) and levels of glycosylated haemoglobin (HR=1.28; p=0.011). Patients with LVD had significantly worse outcome than those without (χ(2)=4.73; p=0.030).


CONCLUSIONS
Subclinical LVD is common in asymptomatic patients with type 2 DM, is readily detectable by GLS imaging and is independently associated with adverse outcome.


BACKGROUND
Australian and New Zealand Clinical Trials Registry (ACTRN12612001178831).
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia School of Human Movement Studies, The University of Queensland, Brisbane, Queensland, Australia.
David J
DJ
Holland
Menzies Research Institute Tasmania, Hobart, Tasmania, Australia.
Thomas H
TH
Marwick
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Brian A
BA
Haluska
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Rodel
R
Leano
School of Human Movement Studies, The University of Queensland, Brisbane, Queensland, Australia.
Matthew D
MD
Hordern
Heart Centre, The Alfred Hospital, Melbourne, Victoria, Australia Baker IDI Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.
James L
JL
Hare
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Zhi You
ZY
Fang
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia Mater Medical Research Institute Brisbane, Brisbane, Queensland, Australia.
Johannes B
JB
Prins
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Tony
T
Stanton
D000368:Aged; D058070:Asymptomatic Diseases; D001315:Australia / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology; D042241:Early Diagnosis; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D013995:Time; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology