Background
Methods
Study population
Ethics, consent and permissions
Clinical features
Depression assessment
Echocardiography
Outcomes
Statistical analysis
Results
Patient characteristics
Demographic and clinical characteristics | |
Age (years) | 71 ± 4.4 |
Male gender (n, %) | 150 (54.7) |
Weight (kg) | 85.8 ± 17.2 |
Height (cm) | 168.4 ± 10.0 |
BMI (kg/m2) | 30.3 ± 5.9 |
Waist circumference (cm) | 103.2 ± 13.3 |
Obesity (n, %) | 135 (49.3) |
Heart rate (n/min) | 69 ± 11 |
Systolic blood pressure (mmHg) | 139 ± 15 |
Diastolic blood pressure (mmHg) | 81 ± 10 |
Hypertension (n, %) | 204 (74.4) |
Family history of HF (n, %) | 80 (29.2) |
Past chemotherapy (n, %) | 25 (9.1) |
Past heart disease (n, %) | 16 (5.8) |
Medication | |
Insulin (n, %) | 65 (23.7) |
Metformin (n, %) | 184 (67.2) |
ACEi/ARB (n, %) | 183 (66.8) |
Beta-blockers (n, %) | 15 (5.5) |
Calcium antagonists (n, %) | 64 (23.4) |
Diuretics (n, %) | 31 (11.3) |
Lipid lowering meds (n, %) | 133 (48.5) |
Questionnaire | |
PHQ-9 score | 3.2 ± 4.3 |
0–4 | 210 (76.7) |
5–9 | 37 (13.5) |
10–20 | 25 (9.1) |
≥ 20 | 2 (0.7) |
Echocardiography | |
LV ejection fraction (%) | 63.1 ± 6.4 |
Mitral early-diastolic inflow velocity (E wave) (m/s) | 0.65 ± 0.17 |
Mitral late-diastolic inflow velocity (A wave) (m/s) | 0.83 ± 0.19 |
Transmitral diastolic flow velocity ratio (E/A) | 0.79 ± 0.22 |
Early diastolic mitral annular velocity (e′) (m/s) | 0.08 ± 0.02 |
Mitral E/e′ septal–lateral ratio (E/e′) | 9.2 ± 2.8 |
E/e′ ratio > 13 (n, %) | 29 (10.6) |
Deceleration time (DT) (s) | 246.8 ± 52.4 |
LV mass index (g/m2) | 85.7 ± 19.0 |
LV mass index (g/m1.7) | 74.4 ± 20.8 |
LV hypertrophy (n, %)a | 36 (13.2) |
Biochemical characteristics | |
HbA1c (mmol/mol) (n = 274) | 53.5 ± 10.1 |
Fasting glucose (µmol/L) (n = 109) | 8.3 ± 3.5 |
Creatinine (µmol/L) (n = 186) | 81.3 ± 24.0 |
eGFR (mL/min/1.73 m2) (n = 187) | |
≥ 90 | 37 (19.8) |
60–89 | 115 (61.5) |
45–59 | 25 (13.4) |
30–44 | 9 (4.8) |
15–29 | 1 (0.5) |
Depression
Depression (n = 25) | No depression (n = 229) | p | |
---|---|---|---|
Demographic and clinical characteristics | |||
Age (years) | 70.6 ± 3.8 | 70.9 ± 4.4 | 0.418 |
Male gender (n, %) | 11 (44.0) | 131 (57.2) | 0.208 |
Weight (kg) | 92.6 ± 22.8 | 85.1 ± 16.5 | 0.122 |
BMI (kg/m2) | 34.1 ± 7.8 | 29.8 ± 5.6 |
0.012
|
Waist circumference (cm) | 109.0 ± 14.2 | 102.4 ± 13.1 |
0.032
|
Obesity (n, %) | 18 (72.0) | 106 (46.3) |
0.015
|
Heart rate (n/min) | 70 ± 11 | 68 ± 11 | 0.280 |
Systolic blood pressure (mmHg) | 138 ± 17 | 139 ± 14 | 0.936 |
Diastolic blood pressure (mmHg) | 80 ± 12 | 81 ± 9 | 0.748 |
Hypertension (n, %) | 19 (76.0) | 171 (74.7) | 0.985 |
Family history of HF (n, %) | 10 (40.0) | 63 (27.5) | 0.191 |
Past chemotherapy (n, %) | 4 (16.0) | 18 (7.9) | 0.170 |
Past heart disease (n, %) | 3 (12.0) | 11 (4.8) | 0.135 |
HbA1c (mmol/mol) | 57.6 ± 10.6 | 53.0 ± 10.0 |
0.049
|
HbA1c > 64 mmol/mol (n, %) | 8 (32) | 24 (10.5) |
0.002
|
Medication | |||
Insulin (n, %) | 11 (44.0) | 49 (21.4) |
0.012
|
Metformin (n, %) | 18 (72.0) | 157 (68.6) | 0.725 |
ACEi/ARB (n, %) | 19 (76.0) | 152 (66.4) | 0.331 |
Beta-blockers (n, %) | 1 (4.0) | 14 (6.1) | 0.571 |
Calcium antagonists (n, %) | 7 (28.0) | 54 (23.6) | 0.524 |
Diuretics (n, %) | 4 (16.0) | 23 (10.0) | 0.360 |
Lipid lowering meds (n, %) | 14 (56.0) | 109 (47.5) | 0.426 |
Echocardiography | |||
LV ejection fraction (%) | 61.5 ± 8.7 | 63.2 ± 6.2 | 0.222 |
Mitral early-diastolic inflow velocity (E wave) (m/s) | 0.62 ± 0.18 | 0.65 ± 0.16 | 0.530 |
Mitral late-diastolic inflow velocity (A wave) (m/s) | 0.81 ± 0.16 | 0.83 ± 0.19 | 0.525 |
Transmitral diastolic flow velocity ratio (E/A) | 0.79 ± 0.21 | 0.77 ± 0.25 | 0.693 |
Early diastolic mitral annular velocity (e′) (m/s) | 0.07 ± 0.01 | 0.08 ± 0.02 | 0.852 |
Mitral E/e′ septal–lateral ratio (E/e′) | 8.6 ± 1.9 | 9.2 ± 2.8 | 0.336 |
E/e′ ratio > 13 (n, %) | 1 (4.0) | 25 (10.9) | 0.280 |
Deceleration time (DT) (s) | 231.6 ± 50.4 | 248.6 ± 52.9 | 0.129 |
LV mass index (g/m2) | 87.3 ± 16.1 | 85.4 ± 19.6 | 0.602 |
LV mass index (g/m1.7) | 82.3 ± 27.0 | 73.6 ± 20.2 | 0.130 |
LV hypertrophy (n, %)a | 2 (8.0) | 33 (14.4) | 0.998 |
Follow-up
HR (95% CI) | p value | |
---|---|---|
Demographic and clinical characteristics | ||
Age | 1.06 (0.99, 1.32) | 0.064 |
Male gender (yes/no) | 1.81 (0.92, 3.56) | 0.086 |
Weight | 1.04 (1.02, 1.05) | < 0.001 |
BMI | 1.10 (1.06, 1.15) | < 0.001 |
Waist circumference | 1.05 (1.03, 1.08) | < 0.001 |
Obesity (yes/no) | 3.61 (1.76, 7.39) | < 0.001 |
Heart rate | 0.99 (0.97, 1.03) | 0.727 |
Systolic blood pressure | 0.99 (0.97, 1.01) | 0.314 |
Diastolic blood pressure | 0.90 (0.99, 1.03) | 0.895 |
Hypertension (yes/no) | 1.07 (0.52, 2.19) | 0.854 |
Family history of HF (yes/no) | 0.70 (0.33, 1.47) | 0.349 |
Past chemotherapy (yes/no) | 1.54 (0.60, 3.93) | 0.536 |
Past heart disease (yes/no) | 1.46 (0.45, 4.74) | 0.529 |
HbA1c (mmol/mol) | 1.03 (1.01, 1.06) |
0.009
|
HbA1c > 64 mmol/mol (n, %) | 3.27 (1.66, 6.43) |
0.001
|
Medication | ||
Insulin (yes/no) | 1.77 (0.92, 3.39) | 0.086 |
Metformin (yes/no) | 0.72 (0.38, 1.36) | 0.310 |
ACEi/ARB (yes/no) | 1.12 (0.57, 2.20) | 0.749 |
Beta-blockers (yes/no) | 3.25 (1.36, 7.77) |
0.008
|
Calcium antagonists (yes/no) | 0.50 (0.21, 1.18) | 0.114 |
Diuretics (yes/no) | 0.91 (0.33, 2.65) | 0.909 |
Lipid lowering med (yes/no) | 1.32 (0.71, 2.48) | 0.382 |
Questionnaire | ||
PHQ-9 score (continuous) | 1.08 (1.01, 1.16) |
0.021
|
PHQ-9 score ≥ 10 (yes/no) | 3.21 (1.41, 7.30) |
0.005
|
PHQ-9 score (categorical) | ||
0–4 | Ref | |
5–9 | 0.58 (0.18, 1.89) | 0.362 |
≥ 10 | 3.01 (1.32, 6.89) |
0.009
|
Echocardiography | ||
LV ejection fraction | 0.95 (0.90, 0.99) |
0.018
|
Mitral early-diastolic inflow velocity (E wave) | 3.46 (0.54, 22.39) | 0.192 |
Mitral late-diastolic inflow velocity (A wave) | 1.81 (0.32, 10.31) | 0.503 |
Transmitral diastolic flow velocity ratio (E/A) | 0.92 (0.16, 5.31) | 0.929 |
Early diastolic mitral annular velocity (e′) | 1.05 (0.86, 1.28) | 0.644 |
Mitral E/e′ septal–lateral ratio | 1.05 (0.94, 1.17) | 0.437 |
E/e′ ratio > 13 (yes/no) | 1.04 (0.37, 2.94) | 0.934 |
Deceleration time (DT) | 0.99 (0.99, 1.00) | 0.363 |
LV mass index (g/m2) | 1.03 (1.02, 1.04) | < 0.001 |
LV mass index (g/m1.7) | 1.03 (1.02, 1.04) | < 0.001 |
LV hypertrophy (yes/no)a | 3.92 (2.04, 7.52) | < 0.001 |
Variable | No. of patients | No. of HF | No. of death | Unadjusted HR (95% CI) p value | LVH-adjusted HR (95% CI)a p value | E/e′-adjusted HR (95% CI)b p value | Adjusted HR (95% CI)c p value |
---|---|---|---|---|---|---|---|
Age | 254 | 37 | 3 | 1.06 (0.99, 1.13) 0.064 | – | – | 1.06 (0.99, 1.14) 0.055 |
Male gender | 142 | 25 | 3 | 1.81 (0.92, 3.56) 0.086 | – | – | 1.36 (0.61, 2.92) 0.466 |
Obesity | 124 | 29 | 1 | 3.61 (1.76, 7.39) < 0.001 | 2.87 (1.38, 5.98)
0.005
| 3.27 (1.58, 5.75)
0.001
| 2.97 (1.44, 6.30)
0.004
|
HbA1c | 32 | 10 | 2 | 3.27 (1.66, 6.43)
0.001
| 2.04 (0.99, 4.22) 0.054 | 2.47 (1.22, 5.00)
0.012
| 2.01 (0.93, 4.10) 0.077 |
LVH | 35 | 13 | 1 | 3.92 (2.04, 7.52) < 0.001 | 3.24 (1.65, 6.38)
0.001
| – | 2.67 (1.25, 5.99)
0.011
|
E/e′ | 26 | 4 | 0 | 1.04 (0.37, 2.94) 0.934 | – | 1.11 (0.39, 3.18) 0.845 | 0.82 (0.26, 2.52) 0.724 |
Depression | 25 | 7 | 0 | 3.21 (1.41, 7.30)
0.005
| 2.80 (1.16, 6.76)
0.022
| 2.39 (1.01, 5.67)
0.048
| 3.14 (1.27, 7.74)
0.013
|