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Original article
Impact of left ventricular longitudinal diastolic functional reserve on clinical outcome in patients with type 2 diabetes mellitus
  1. Sung-Ai Kim,
  2. Chi-Young Shim,
  3. Jin-Mi Kim,
  4. Hyun-Jin Lee,
  5. Dong-Hoon Choi,
  6. Eui-Young Choi,
  7. Yangsoo Jang,
  8. Namsik Chung,
  9. Jong-Won Ha
  1. Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
  1. Correspondence to Jong-Won Ha, Cardiology Division, Severance Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei University College of Medicine. Seodaemun-Gu Shinchon-Dong 134, 120-752 Seoul, South Korea; jwha{at}yuhs.ac

Abstract

Background Left ventricular longitudinal diastolic functional reserve (DFR), as assessed by the change in early diastolic mitral annular velocity (E′) during exercise, is abnormal in patients with type 2 diabetes mellitus (DM). However, the impact of left ventricular longitudinal DFR on clinical outcome has not been explored. This study evaluated the incremental prognostic value of left ventricular DFR in patients with type 2 DM without overt heart disease.

Methods Of 1485 patients who were referred for exercise stress echocardiography, 197 consecutive patients (mean age, 58 years; 84 men) with type 2 DM without overt heart disease were identified. Left ventricular longitudinal DFR was defined as the change in E′ from resting to exercise (ΔE′). The endpoint was a composite of death and hospitalisation for heart failure (HF).

Results During a median follow-up of 57 months (range 6–90), 18 of 197 patients (9.1%) had adverse events (12 deaths, six hospitalisations for HF). Independent predictors of adverse events in a Cox regression analysis were estimated glomerular filtration rate (HR 0.97; 95% CI 0.95 to 0.98; p<0.001), DM duration (HR 1.07; 95% CI 1.01 to 1.14; p=0.018) and ΔE′ (HR 0.58; 95% CI 0.40 to 0.85; p=0.005). In an incremental model, the addition of stress echo data significantly increased the χ2 of the clinical and resting left ventricular function model, from 40.5 to 46.6 (p=0.005).

Conclusion Assessment of left ventricular longitudinal DFR during exercise provided incremental prognostic information in patients with type 2 DM without overt heart disease.

  • Diabetes mellitus
  • diastole
  • diastolic dysfunction
  • echocardiography
  • exercise

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Footnotes

  • Funding This work was supported by the Korea Science and Engineering Foundation (KOSEF) grant funded by the Korean government (M10642120001-06N4212-00110).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the institutional review board of Yonsei University College of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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