Diastolic Dysfunction Found in 24% of Diabetes Patients

NEW ORLEANS — Preclinical diastolic dysfunction was highly prevalent among patients with diabetes, occurring in 24% of more than 1,700 largely unselected patients in a retrospective study.

Diastolic dysfunction without any clinical manifestations in patients with either type 1 or type 2 diabetes also had substantial clinical consequences, leading to a significantly increased rate of both heart failure and all-cause mortality during up to 5 years of follow-up, Dr. Aaron M. From reported at the annual scientific sessions of the American Heart Association.

Because the increased risk for heart failure in patients with diabetes and diastolic dysfunction was independent of both hypertension and coronary artery disease, “we suspect that the cardiomyopathy may be a direct consequence of diabetes itself,” said Dr. From, a cardiologist at the Mayo Clinic in Rochester, Minn.

He and his associates studied the natural history of preclinical diastolic dysfunction in diabetes patients by reviewing the records of 2,770 patients with type 1 or type 2 diabetes who were residents of Olmsted County, Minn., and who had an echocardiographic exam at the Mayo Clinic during 1996–2006. The analysis excluded 975 patients who were diagnosed with heart failure within 30 days of their echo exam, and 1 patient with severe heart-valve regurgitation, leaving 1,794 in the analysis. The patients' average age was 60, about half were women, their average body mass index was 33 kg/m

Diastolic dysfunction was identified by calculating the ratio of a patient's early mitral filling velocity—the E wave—and the mitral annulus velocity—the e: wave—obtained from the echo results. If the E/e: ratio was more than 15, the patient was deemed to have diastolic dysfunction. Using this criterion, 431 (24%) of the 1,784 patients with diabetes had diastolic dysfunction at the time of their echo exam. Subsequent development of heart failure was identified by finding ICD-9 code 428 in the patient's record.

Clinical follow-up data were available for an average of 2.7 years following the echo exam, and for periods as long as 5 years. During follow-up, the rate of new-onset heart failure was 37% in patients with diastolic dysfunction at baseline and 17% in those without diastolic dysfunction, a statistically significant difference, said Dr. From, who reported that he and his coauthors had no conflicts of interest related to the study.

In a multivariate analysis controlling for baseline differences in age, sex, body mass index, hypertension, coronary disease, ejection fraction, left atrial volume, and deceleration time, diabetes patients with diastolic dysfunction were 67% more likely to develop heart failure.

During up to 5 years of follow-up, the rate of death from any cause was 33% in patients with diastolic dysfunction at baseline and 13% in those without dysfunction, also a significant difference. In a multivariate analysis that controlled for the same baseline variables, patients with diastolic dysfunction had an 88% higher risk of dying from any cause than did patients without dysfunction at the time of their echo exam.

NEW ORLEANS — Preclinical diastolic dysfunction was highly prevalent among patients with diabetes, occurring in 24% of more than 1,700 largely unselected patients in a retrospective study.

Diastolic dysfunction without any clinical manifestations in patients with either type 1 or type 2 diabetes also had substantial clinical consequences, leading to a significantly increased rate of both heart failure and all-cause mortality during up to 5 years of follow-up, Dr. Aaron M. From reported at the annual scientific sessions of the American Heart Association.

Because the increased risk for heart failure in patients with diabetes and diastolic dysfunction was independent of both hypertension and coronary artery disease, “we suspect that the cardiomyopathy may be a direct consequence of diabetes itself,” said Dr. From, a cardiologist at the Mayo Clinic in Rochester, Minn.

He and his associates studied the natural history of preclinical diastolic dysfunction in diabetes patients by reviewing the records of 2,770 patients with type 1 or type 2 diabetes who were residents of Olmsted County, Minn., and who had an echocardiographic exam at the Mayo Clinic during 1996–2006. The analysis excluded 975 patients who were diagnosed with heart failure within 30 days of their echo exam, and 1 patient with severe heart-valve regurgitation, leaving 1,794 in the analysis. The patients' average age was 60, about half were women, their average body mass index was 33 kg/m

Diastolic dysfunction was identified by calculating the ratio of a patient's early mitral filling velocity—the E wave—and the mitral annulus velocity—the e: wave—obtained from the echo results. If the E/e: ratio was more than 15, the patient was deemed to have diastolic dysfunction. Using this criterion, 431 (24%) of the 1,784 patients with diabetes had diastolic dysfunction at the time of their echo exam. Subsequent development of heart failure was identified by finding ICD-9 code 428 in the patient's record.

Clinical follow-up data were available for an average of 2.7 years following the echo exam, and for periods as long as 5 years. During follow-up, the rate of new-onset heart failure was 37% in patients with diastolic dysfunction at baseline and 17% in those without diastolic dysfunction, a statistically significant difference, said Dr. From, who reported that he and his coauthors had no conflicts of interest related to the study.

In a multivariate analysis controlling for baseline differences in age, sex, body mass index, hypertension, coronary disease, ejection fraction, left atrial volume, and deceleration time, diabetes patients with diastolic dysfunction were 67% more likely to develop heart failure.

During up to 5 years of follow-up, the rate of death from any cause was 33% in patients with diastolic dysfunction at baseline and 13% in those without dysfunction, also a significant difference. In a multivariate analysis that controlled for the same baseline variables, patients with diastolic dysfunction had an 88% higher risk of dying from any cause than did patients without dysfunction at the time of their echo exam.

NEW ORLEANS — Preclinical diastolic dysfunction was highly prevalent among patients with diabetes, occurring in 24% of more than 1,700 largely unselected patients in a retrospective study.

Diastolic dysfunction without any clinical manifestations in patients with either type 1 or type 2 diabetes also had substantial clinical consequences, leading to a significantly increased rate of both heart failure and all-cause mortality during up to 5 years of follow-up, Dr. Aaron M. From reported at the annual scientific sessions of the American Heart Association.

Because the increased risk for heart failure in patients with diabetes and diastolic dysfunction was independent of both hypertension and coronary artery disease, “we suspect that the cardiomyopathy may be a direct consequence of diabetes itself,” said Dr. From, a cardiologist at the Mayo Clinic in Rochester, Minn.

He and his associates studied the natural history of preclinical diastolic dysfunction in diabetes patients by reviewing the records of 2,770 patients with type 1 or type 2 diabetes who were residents of Olmsted County, Minn., and who had an echocardiographic exam at the Mayo Clinic during 1996–2006. The analysis excluded 975 patients who were diagnosed with heart failure within 30 days of their echo exam, and 1 patient with severe heart-valve regurgitation, leaving 1,794 in the analysis. The patients' average age was 60, about half were women, their average body mass index was 33 kg/m

Diastolic dysfunction was identified by calculating the ratio of a patient's early mitral filling velocity—the E wave—and the mitral annulus velocity—the e: wave—obtained from the echo results. If the E/e: ratio was more than 15, the patient was deemed to have diastolic dysfunction. Using this criterion, 431 (24%) of the 1,784 patients with diabetes had diastolic dysfunction at the time of their echo exam. Subsequent development of heart failure was identified by finding ICD-9 code 428 in the patient's record.

Clinical follow-up data were available for an average of 2.7 years following the echo exam, and for periods as long as 5 years. During follow-up, the rate of new-onset heart failure was 37% in patients with diastolic dysfunction at baseline and 17% in those without diastolic dysfunction, a statistically significant difference, said Dr. From, who reported that he and his coauthors had no conflicts of interest related to the study.

In a multivariate analysis controlling for baseline differences in age, sex, body mass index, hypertension, coronary disease, ejection fraction, left atrial volume, and deceleration time, diabetes patients with diastolic dysfunction were 67% more likely to develop heart failure.

During up to 5 years of follow-up, the rate of death from any cause was 33% in patients with diastolic dysfunction at baseline and 13% in those without dysfunction, also a significant difference. In a multivariate analysis that controlled for the same baseline variables, patients with diastolic dysfunction had an 88% higher risk of dying from any cause than did patients without dysfunction at the time of their echo exam.