title: Impact of type 2 diabetes and duration of type 2 diabetes on cardiac structure and function.
abstract: BACKGROUND
  Contemporary treatment of type 2 diabetes (T2D) has improved patient outcome and may also have affected myocardial structure and function. We aimed to describe the effect of T2D and T2D duration on cardiac structure and function in a large outpatient population.
  
  
  METHODS
  We performed comprehensive echocardiography on a representative sample of 1004 persons including a representative sample of 770 patients with T2D without known heart disease and 234 age- and sex-matched controls.
  
  
  RESULTS
  T2D was associated with increased left ventricular (LV) wall thicknesses and decreased LV internal diameter and the changes were pronounced with increasing diabetes duration (P<0.01 for all) but not with increased LV mass (P=0.74). It was also significantly associated with the prevalence of diastolic dysfunction (16.5% vs. 4.0%; P<0.001), with indices of LV relaxation and elevated filling pressures expressed as e'septal (mean: 6.9 (SD: 1.9) cm/s vs. 7.5 (2.4); P<0.001) and E/e'septal (median: 10.8 (interquartile range (IQR): 9.1-13.3) vs. 9.1 (7.2-11.1); P<0.001) and global longitudinal strain (mean: -14.1 (SD: 2.4) vs. -15.0 (2.0), P<0.001) but not with LV ejection fraction (median: 60.8 (IQR: 56.5-65.1) vs. 62.1 (57.9-65.4), P=0.28). With the exception of global longitudinal strain, this was pronounced with increasing diabetes duration for all measures including increasing diastolic dysfunction (<10years: 10.8%, 10-20years: 18.5%, >20years: 24.8%; P<0.001). The increased risk of diastolic dysfunction persisted after multivariable adjustment (P=0.013).
  
  
  CONCLUSIONS
  In patients with T2D, LV structural and functional alterations persist and are accentuated with increasing diabetes duration despite reductions in overall risk of cardiovascular disease in this patient population.
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N., Denmark. Electronic address: petergodsk@gmail.com.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Jørgensen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark.
authors.forename: Magnus T
authors.initials: MT
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Mogelvang
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fritz-Hansen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Galatius
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark.
authors.forename: Tor
authors.initials: T
authors.lastname: Biering-Sørensen
authors.affiliation: Center for Diabetes Research, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark.
authors.forename: Heidi
authors.initials: H
authors.lastname: Storgaard
authors.affiliation: Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N., Denmark; Center for Diabetes Research, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark.
authors.forename: Tina
authors.initials: T
authors.lastname: Vilsbøll
authors.affiliation: Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N., Denmark; Steno Diabetes Center, Niels Steensens Vej 2-2, DK-2820 Gentofte, Denmark; Faculty of Health, Aarhus University, Nordre Ringgade 1, DK-8000 Aarhus C, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N., Denmark.
authors.forename: Jan S
authors.initials: JS
authors.lastname: Jensen
mesh_terms: D000368:Aged; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D013223:Statistics as Topic; D013318:Stroke Volume; D013995:Time; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology; D020257:Ventricular Remodeling
keywords: Echocardiography; Heart failure; Type 2 diabetes