The Development of Heart Failure in Patients With Diabetes Mellitus and Pre-Clinical Diastolic Dysfunction
Open accessAbstract
Objectives The purpose of this study was to evaluate the outcomes of pre-clinical diastolic dysfunction in diabetic patients.Background Studies have reported a high prevalence of pre-clinical diastolic dysfunction among patients with diabetes mellitus.Methods We identified all diabetic patients with a tissue Doppler imaging assessment of diastolic function in Olmsted County, Minnesota, from 2001 to 2007. Diastolic dysfunction was defined as a passive transmitral left ventricular (LV) inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (E/e') ratio >15. The main outcome was the development of heart failure (HF). Secondary outcomes were the development of atrial fibrillation and death.Results Overall, 1,760 diabetic patients with a tissue Doppler echocardiographic assessment of diastolic function were identified; 411 (23%) patients had diastolic dysfunction. Using multivariable Cox's proportional hazard modeling, we determined that for every 1-U increase in the passive transmitral LV inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (E/e') ratio, the hazard ratio (HR) of HF increased by 3% (HR: 1.03; 95% confidence interval [CI]: 1.01 to 1.06; p = 0.006) and that diastolic dysfunction was associated with the subsequent development of HF after adjustment for age, sex, body mass index, hypertension, coronary disease, and echocardiographic parameters (HR: 1.61; 95% CI: 1.17 to 2.20; p = 0.003). The cumulative probability of the development of HF at 5 years for diabetic patients with diastolic dysfunction was 36.9% compared with 16.8% for patients without diastolic dysfunction (p < 0.001). Furthermore, diabetic patients with diastolic dysfunction had a significantly higher mortality rate compared with those without diastolic dysfunction.Conclusions We demonstrated that an increase in the passive transmitral LV inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (E/e') ratio in diabetic patients is associated with the subsequent development of HF and increased mortality independent of hypertension, coronary disease, or other echocardiographic parameters.
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Diabetic patients with subclinical diastolic dysfunction have a 5-year mortality rate of 30.8% compared to 12.1% for diabetic patients with no diastolic dysfunction.
“Diabetic patients with subclinical diastolic dysfunction have a 5-year mortality rate of 30.8% compared to 12.1% for diabetic patients with no diastolic dysfunction [4].”
From Role of Serum Biomarkers in Early Detection of Diabetic Cardiomyopathy in the West Virginian Population (2016) · cites this paper as [4]
The Discussion (page unavailable) says preclinical diastolic dysfunction in diabetic patients was associated with increased mortality, supporting the direction of the comparison. The retrieved Results passages do not give the claimed five-year mortality rates of 30.8% and 12.1%; a separate Results passage gives five-year rates for heart failure, not death. (LLM, conf=0.82)
Experimental — accuracy not yet measuredDiabetic cardiomyopathy (DCM) is an established complication of diabetes mellitus.
“Diabetic cardiomyopathy (DCM) is an established complication of diabetes mellitus.”
From Role of Serum Biomarkers in Early Detection of Diabetic Cardiomyopathy in the West Virginian Population (2016) · cites this paper as [4]
The Introduction describes diabetic cardiomyopathy as a proposed primary myocardial disease, rather than calling it an established complication. The Discussion and Conclusion report that preclinical diastolic dysfunction is prevalent in patients with diabetes, which supports an associated cardiac abnormality but not the stronger claim about diabetic cardiomyopathy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredDiastolic dysfunction is a strong predictor of incident HF and CV mortality in T2DM.
“Furthermore, the diastolic dysfunction is a strong predictor of incident HF and CV mortality in T2DM [81,82].”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [81]
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- Authors
- From, A. M., Scott, C. G., & Chen, H. H.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Chen, Horng H.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2010-01
- Volume
- 55
- Issue
- 4
- Pages
- 300-305
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC3878075
- OpenAlex
- W50284947
- Cited by
- 469
- References
- 28
- Citations by year
- 2026: 17 · 2025: 21 · 2024: 26 · 2023: 26 · 2022: 30 · 2021: 30 · 2020: 37 · 2019: 40 · 2018: 30 · 2017: 37 · 2016: 35 · 2015: 37 · 2014: 31 · 2013: 20 · 2012: 21
- FWCI
- 15.38
- Type
- journal article
- Language
- en
- Update notices
- erratum (2010-11-02)
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (HL 76611-04-P4)
- national Institute of Arthritis, Musculoskeletal and Skin Diseases (R01-AR30582)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- diabetes mellitus, E/e' ratio, tissue Doppler imaging, left ventricular diastolic function, mortality, atrial fibrillation
- MeSH terms
- Aged, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Echocardiography, Doppler, Ventricular Dysfunction, Left, Diabetes Complications, Heart Failure, Diastolic
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