Echocardiography refines cardiovascular risk in type 1 diabetes
medwireNews: Routine echocardiographic measures of myocardial dysfunction improve on the ability of clinical risk factors to predict major adverse cardiovascular events (MACE) in people with type 1 diabetes, say researchers.
For the prospective Thousand & 1 Study, 1093 people with type 1 diabetes (53% men) from the Steno Diabetes Center in Copenhagen, Denmark, underwent echocardiography, at an average age of 50.2 years.
During a median 6.5 years of follow-up, 145 of these participants had MACE, defined as hospitalization for acute coronary syndromes, heart failure, or stroke; revascularization; or death from any cause.
People who had MACE were more than 10 years older, on average, than those who did not, were more often male and more likely to have ever smoked, and had higher blood pressure and poorer kidney function.
Nonetheless, all echocardiographic measures significantly predicted MACE after accounting for these differences, Magnus Jensen (Copenhagen University Hospital Herlev-Gentofte, Denmark) and co-researchers report in Diabetologia.
Specifically, a left ventricular ejection fraction (LVEF) below 45% was associated with a 3.93-fold increased risk for MACE and impaired global longitudinal strain (GLS) with a 1.65-fold increase. In addition, moderately elevated (8–12) and high (≥12) ratios of early mitral peak diastolic to diastolic tissue Doppler velocity (E/e’) were associated with respective 1.59- and 2.30-fold risk increases.
“[S]o far, best practice guidelines for the monitoring of people with type 1 diabetes do not include echocardiography or any other regular examination of the heart,” say the researchers.
Yet they found that these echocardiographic parameters improved risk prediction over and above the Steno T1D Risk Engine, which they say is “superior to other risk models in type 1 diabetes.”
Adding information about moderately elevated or high E/e’, which the researchers say is “the hallmark of diabetic cardiomyopathy,” significantly improved all three predictive measures used (C-statistic, net reclassification index, and integrated discrimination improvement), while impaired GLS improved two of the measures.
Inclusion of LVEF did not significantly improve any predictive measure, which “may seem counterintuitive considering the highly increased risk estimate from the time-to-event data, but this is explained by the low prevalence of grossly reduced ejection fraction in the present cohort,” says the team.
Only 18 people had a reduced LVEF, which Jensen and team attribute to the relatively young age of the cohort overall.
“Together, our findings suggest that echocardiography added to the standard clinical follow-up in type 1 diabetes is a feasible method for detecting early myocardial dysfunction and identifying individuals at particular risk of adverse events,” conclude the researchers.
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