Left ventricular dysfunction and outcome at two-year follow-up in patients with type 2 diabetes: The DYDA study

https://doi.org/10.1016/j.diabres.2013.05.010Get rights and content

Abstract

Aims

Left ventricular dysfunction (LVD) in type 2 diabetes mellitus (DM) (DYDA) study is a prospective investigation enrolling 960 with DM without overt cardiac disease. At baseline, a high prevalence of LVD was detected by analysing midwall shortening. We report here the incidence of clinical events in DYDA patients after 2-year follow-up and the frequency of LVD detected at baseline and 2-year evaluation.

Methods

Systolic LVD was defined as midwall shortening ≤15%, diastolic LVD as any condition different from “normal diastolic function” identified as E/A ratio on Doppler mitral flow between 0.75 and 1.5 and deceleration time of E wave >140 ms. Major outcome was a composite of major events, including all-causes death and hospital admissions.

Results

During the study period, any systolic/diastolic LVD was found in 616 of 699 patients (88.1%) in whom LVD function could be measured at baseline or at 2 years. Older age and high HbA1c predicted the occurrence of LVD. During the follow-up 15 patients died (1.6%), 3 for cardiovascular causes, 139 were hospitalized (14.5%, 43 of them for cardiovascular causes, 20 for a new cancer).

Conclusions

During a 2-year follow-up any LVD is detectable in a large majority of patients with DM without overt cardiac disease. Older age and higher HbA1c predict LVD. All-cause death or hospitalization occurred in 15% of patients, cardiovascular cause was uncommon. Independent predictors of events were older age, pathologic lipid profile, high HbA1c, claudicatio and repaglinide therapy. Echo-assessed LVD at baseline was not prognosticator of events.

Introduction

The risk to develop heart failure (HF) is high in patients with type 2 diabetes mellitus (DM) independently of the coexistence of ischemic heart disease, and their prognosis, once HF happens, is poorer than that of patients without DM [1], [2], [3], [4], [5]. In patients with DM, left ventricular (LV) performance insidiously progresses from a normal state to asymptomatic systolic and/or diastolic dysfunction (LVD) which may herald, in some case, overt HF [6], [7], [8], [9], [10]. We recently published the results of baseline echocardiographic examination performed in a large cohort of patients with DM without overt cardiac disease (DYDA study) [11], [12]. The analyses of our data showed an unexpectedly high prevalence of LVD in these asymptomatic subjects who were successively followed-up for 2 years. In the present study, we analyze data on the echocardiographic re-evaluation and clinical events to assess:

  • 1.

    The presence and predictors of systolic and/or diastolic LVD detected at baseline or at 2-year follow-up;

  • 2.

    The incidence and predictors of a combined outcome measure of all-cause death and hospitalizations at 2-year follow-up.

Section snippets

Design and methods

Study population. DYDA was a prospective, multicenter, nationwide study, promoted by the Italian Association of Hospital Cardiologists (ANMCO) and the Italian Association of Clinical Diabetologists (AMD), evaluating clinical and echocardiographic characteristics of a large cohort of individuals with DM. Inclusion and exclusion criteria were previously reported [11], [12]. Participants were recruited from July 24, 2006 to March 31, 2008 in 37 Italian diabetes referral centers and underwent a

Results

Patients’ disposition during the study is summarized in Fig. 1. A total of 970 subjects were enrolled in the DYDA study. Ten patients were excluded from the analyses due to protocol violations, leaving a study population of 960 patients. Three patients were lost to follow-up, so two-year survival and hospitalizations’ data were available in 957 patients. Baseline characteristics of the study population are reported in Table 1. Of note, more than one third of patients were obese, systolic blood

Discussion

DM is a strong predictor of incident HF, independent of both coexisting myocardial infarction and other cardiovascular risk factors [1]. Recently, it has been established that DM increases hazard of HF by 66% [20]. The results of the present study show that in asymptomatic patients with DM, systolic and/or diastolic LVD may frequently be detected at baseline evaluation and/or develop subsequently in a relatively short time. In our experience, any LVD was detected during the study in about 90%

Funding

The study was partially supported by an unrestricted grant from Sanofi-Aventis.

Analytical work was partly supported by Ministero della Salute, project RF-FCG-2006-379933.

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgments

We thank Renato Urso, MSc for statistical advice.

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    On behalf of the DYDA Investigators. See the Appendix for a complete list of participating Centers and Investigators.

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