title: suPAR level is associated with myocardial impairment assessed with advanced echocardiography in patients with type 1 diabetes with normal ejection fraction and without known heart disease or end-stage renal disease.
abstract: OBJECTIVE
  Heart disease is a common fatal diabetes-related complication. Early detection of patients at particular risk of heart disease is of prime importance. Soluble urokinase plasminogen activator receptor (suPAR) is a novel biomarker for development of cardiovascular disease. We investigate if suPAR is associated with early myocardial impairment assessed with advanced echocardiographic methods.
  
  
  METHODS
  In an observational study on 318 patients with type 1 diabetes without known heart disease and with normal left ventricular ejection fraction (LVEF) (biplane LVEF >45%), we performed conventional, tissue Doppler and speckle tracking echocardiography, and measured plasma suPAR levels. Associations between myocardial function and suPAR levels were studied in adjusted models including significant covariates.
  
  
  RESULTS
  Patients were 55±12 years (mean±s.d.) and 160 (50%) males. Median (interquartile range) suPAR was 3.4 (1.7) ng/mL and LVEF was 58±5%. suPAR levels were not associated with LVEF (P=0.11). In adjusted models, higher suPAR levels were independently associated with both impaired systolic function assessed with global longitudinal strain (GLS) and tissue velocity s', and with impaired diastolic measures a' and e'/a' (all P=0.034). In multivariable analysis including cardiovascular risk factors and both systolic and diastolic measures (GLS and e'/a'), both remained independently associated with suPAR levels (P=0.012).
  
  
  CONCLUSIONS
  In patients with type 1 diabetes with normal LVEF and without known heart disease, suPAR is associated with early systolic and diastolic myocardial impairment. Our study implies that both suPAR and advanced echocardiography are useful diagnostic tools for identifying patients with diabetes at risk of future clinical heart disease, suited for intensified medical therapy.
authors.affiliation: Steno Diabetes CenterGentofte, Denmark ktld@steno.dk.
authors.forename: Simone
authors.initials: S
authors.lastname: Theilade
authors.affiliation: Steno Diabetes CenterGentofte, Denmark Aarhus UniversityAarhus, Denmark University of CopenhagenCopenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.affiliation: Clinical Research CenterHvidovre Hospital, Hvidovre, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Eugen-Olsen
authors.affiliation: University of CopenhagenCopenhagen, Denmark Department of CardiologyGentofte Hospital, Gentofte, Denmark.
authors.forename: Jan S
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Steno Diabetes CenterGentofte, Denmark Department of CardiologyGentofte Hospital, Gentofte, Denmark Department of Internal MedicineHolbaek Sygehus, Holbaek, Denmark.
authors.forename: Magnus T
authors.initials: MT
authors.lastname: Jensen
mesh_terms: D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*
chemical_list: D055293:Receptors, Urokinase Plasminogen Activator