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30.10.2019 | Article

Echocardiography improves prediction of major adverse cardiovascular events in a population with type 1 diabetes and without known heart disease: the Thousand & 1 Study

verfasst von: Magnus T. Jensen, Peter Sogaard, Ida Gustafsson, Jan Bech, Thomas F. Hansen, Thomas Almdal, Simone Theilade, Tor Biering-Sørensen, Peter G. Jørgensen, Søren Galatius, Henrik U. Andersen, Peter Rossing

Erschienen in: Diabetologia | Ausgabe 12/2019

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Abstract

Aims/hypothesis

Cardiovascular disease is the most common comorbidity in type 1 diabetes. However, current guidelines do not include routine assessment of myocardial function. We investigated whether echocardiography provides incremental prognostic information in individuals with type 1 diabetes without known heart disease.

Methods

A prospective cohort of individuals with type 1 diabetes without known heart disease was recruited from the outpatient clinic. Follow-up was performed through Danish national registers. The association of echocardiography with major adverse cardiovascular events (MACE) and the incremental prognostic value when added to the clinical Steno T1D Risk Engine were examined.

Results

A total of 1093 individuals were included: median (interquartile range) age 50.2 (39.2–60.3) years and HbA_1c 65 (56–74) mmol/mol; 53% men; and mean (SD) BMI 25.5 (3.9) kg/m² and diabetes duration 25.8 (14.6) years. During 7.5 years of follow-up, 145 (13.3%) experienced MACE. Echocardiography significantly and independently predicted MACE: left ventricular ejection fraction (LVEF) <45% (n = 18) vs ≥45% (n = 1075), HR (95% CI) 3.93 (1.91, 8.08), p < 0.001; impaired global longitudinal strain (GLS), 1.65 (1.17, 2.34) (n = 263), p = 0.005; diastolic mitral early velocity (E)/early diastolic tissue Doppler velocity (e′) <8 (n = 723) vs E/e′ 8–12 (n = 285), 1.59 (1.04, 2.42), p = 0.031; and E/e′ <8 vs E/e′ ≥12 (n = 85), 2.30 (1.33, 3.97), p = 0.003. In individuals with preserved LVEF (n = 1075), estimates for impaired GLS were 1.49 (1.04, 2.15), p = 0.032; E/e′ <8 vs E/e′ 8–12, 1.61 (1.04, 2.49), p = 0.033; and E/e′ <8 vs E/e′ ≥12, 2.49 (1.41, 4.37), p = 0.001. Adding echocardiographic variables to the Steno T1D Risk Engine significantly improved risk prediction: Harrell’s C statistic, 0.791 (0.757, 0.824) vs 0.780 (0.746, 0.815), p = 0.027; and net reclassification index, 52%, p < 0.001.

Conclusions/interpretation

In individuals with type 1 diabetes without known heart disease, echocardiography significantly improves risk prediction over and above guideline-recommended clinical risk factors alone and could have a role in clinical care.

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de Ferranti SD, de Boer IH, Fonseca V et al (2014) Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Diabetes Care 37(10):2843–2863. https://doi.org/10.2337/dc14-1720 CrossRefPubMedPubMedCentral

Soedamah-Muthu SS, Fuller JH, Mulnier HE, Raleigh VS, Lawrenson RA, Colhoun HM (2006) High risk of cardiovascular disease in patients with type 1 diabetes in the U.K.: a cohort study using the general practice research database. Diabetes Care 29(4):798–804. https://doi.org/10.2337/diacare.29.04.06.dc05-1433 CrossRefPubMed

Laing SP, Swerdlow AJ, Slater SD et al (2003) Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes. Diabetologia 46(6):760–765. https://doi.org/10.1007/s00125-003-1116-6 CrossRefPubMed

Onkamo P, Väänänen S, Karvonen M, Tuomilehto J (1999) Worldwide increase in incidence of type I diabetes--the analysis of the data on published incidence trends. Diabetologia 42(12):1395–1403. https://doi.org/10.1007/s001250051309 CrossRefPubMed

Xu G, Liu B, Sun Y et al (2018) Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. BMJ 362:k1497. https://doi.org/10.1136/bmj.k1497 CrossRefPubMedPubMedCentral

Rydén L, Grant PJ, Anker SD et al (2013) ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the task force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 34(39):3035–3087. https://doi.org/10.1093/eurheartj/eht108

Vistisen D, Andersen GS, Hansen CS et al (2016) Prediction of first cardiovascular disease event in type 1 diabetes mellitus. Circulation 133(11):1058–1066. https://doi.org/10.1161/CIRCULATIONAHA.115.018844 CrossRef

BMJ Best Practice (2018) Type 1 diabetes - monitoring. Available from https://bestpractice.bmj.com/topics/en-gb/25/monitoring. Accessed 28 Oct 2018

Jensen MT, Sogaard P, Andersen HU et al (2014) Prevalence of systolic and diastolic dysfunction in patients with type 1 diabetes without known heart disease: the Thousand & 1 Study. Diabetologia 57(4):672–680. https://doi.org/10.1007/s00125-014-3164-5 CrossRefPubMed

10.

Jensen MT, Sogaard P, Andersen HU et al (2015) Global longitudinal strain is not impaired in type 1 diabetes patients without albuminuria: the Thousand & 1 Study. JACC Cardiovasc Imaging 8(4):400–410. https://doi.org/10.1016/j.jcmg.2014.12.020 CrossRefPubMed

11.

Jensen MT, Sogaard P, Andersen HU et al (2016) Early myocardial impairment in type 1 diabetes patients without known heart disease assessed with tissue Doppler echocardiography: the Thousand & 1 study. Diab Vasc Dis Res 13(4):260–267. https://doi.org/10.1177/1479164116637310 CrossRefPubMed

12.

Nouhravesh N, Andersen HU, Jensen JS, Rossing P, Jensen MT (2016) Retinopathy is associated with impaired myocardial function assessed by advanced echocardiography in type 1 diabetes patients – the Thousand & 1 Study. Diabetes Res Clin Pract 116:263–269. https://doi.org/10.1016/j.diabres.2016.04.024 CrossRefPubMed

13.

Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463. https://doi.org/10.1016/j.echo.2005.10.005 CrossRefPubMed

14.

Nagueh SF, Appleton CP, Gillebert TC et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 10(2):165–193. https://doi.org/10.1093/ejechocard/jep007 CrossRefPubMed

15.

Delgado V, Mollema SA, Ypenburg C et al (2008) Relation between global left ventricular longitudinal strain assessed with novel automated function imaging and biplane left ventricular ejection fraction in patients with coronary artery disease. J Am Soc Echocardiogr 21(11):1244–1250. https://doi.org/10.1016/j.echo.2008.08.010 CrossRefPubMed

16.

Gorcsan J 3rd, Tanaka H (2011) Echocardiographic assessment of myocardial strain. J Am Coll Cardiol 58(14):1401–1413. https://doi.org/10.1016/j.jacc.2011.06.038 CrossRefPubMed

17.

Pandey A, Omar W, Ayers C et al (2018) Sex and race differences in lifetime risk of heart failure with preserved ejection fraction and heart failure with reduced ejection fraction. Circulation 137(17):1814–1823. https://doi.org/10.1161/CIRCULATIONAHA.117.031622 CrossRefPubMedPubMedCentral

18.

Wang Y, Yang H, Huynh Q, Nolan M, Negishi K, Marwick TH (2018) Diagnosis of nonischemic stage b heart failure in type 2 diabetes mellitus: optimal parameters for prediction of heart failure. JACC Cardiovasc Imaging 11(10):1390–1400. https://doi.org/10.1016/j.jcmg.2018.03.015 CrossRefPubMed

19.

Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med 130(6):461–470. https://doi.org/10.7326/0003-4819-130-6-199903160-00002 CrossRefPubMed

20.

Vittinghoff E, McCulloch CE (2007) Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 165(6):710–718. https://doi.org/10.1093/aje/kwk052 CrossRefPubMed

21.

Pencina M, D’Agostino RS, D’Agostino RJ, Vasan R (2008) Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 27:11–21

22.

Pencina M, D’Agostino RS, Steyerberg EW (2011) Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Stat Med 30(1):11–21. https://doi.org/10.1002/sim.4085 CrossRef

23.

Orchard TJ, Stevens LK, Forrest KY, Fuller JH (1998) Cardiovascular disease in insulin dependent diabetes mellitus: similar rates but different risk factors in the US compared with Europe. Int J Epidemiol 27(6):976–983. https://doi.org/10.1093/ije/27.6.976 CrossRefPubMed

24.

Rubler S, Dlugash J, Yuceoglu YZ, Kumral T, Branwood AW, Grishman A (1972) New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 30(6):595–602. https://doi.org/10.1016/0002-9149(72)90595-4 CrossRefPubMed

25.

Fang ZY, Prins JB, Marwick TH (2004) Diabetic cardiomyopathy: evidence, mechanisms, and therapeutic implications. Endocr Rev 25(4):543–567. https://doi.org/10.1210/er.2003-0012 CrossRefPubMed

26.

Gilbert RE, Connelly K, Kelly DJ, Pollock CA, Krum H (2006) Heart failure and nephropathy: catastrophic and interrelated complications of diabetes. Clin J Am Soc Nephrol 1(2):193–208. https://doi.org/10.2215/CJN.00540705 CrossRefPubMed

27.

Fang ZY, Schull-Meade R, Downey M, Prins J, Marwick TH (2005) Determinants of subclinical diabetic heart disease. Diabetologia 48(2):394–402. https://doi.org/10.1007/s00125-004-1632-z CrossRefPubMed

28.

Di Bonito P, Moio N, Cavuto L et al (2005) Early detection of diabetic cardiomyopathy: usefulness of tissue Doppler imaging. Diabet Med J Br Diabet Assoc 22(12):1720–1725. https://doi.org/10.1111/j.1464-5491.2005.01685.x CrossRef

29.

Salem M, El Behery S, Adly A, Khalil D, El Hadidi E (2009) Early predictors of myocardial disease in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 10(8):513–521. https://doi.org/10.1111/j.1399-5448.2009.00517.x CrossRefPubMed

30.

Gul K, Celebi AS, Kacmaz F et al (2009) Tissue Doppler imaging must be performed to detect early left ventricular dysfunction in patients with type 1 diabetes mellitus. Eur J Echocardiogr 10(7):841–846. https://doi.org/10.1093/ejechocard/jep086 CrossRefPubMed

31.

Lo SS, Leslie RD, Sutton MS (1995) Effects of type 1 diabetes mellitus on cardiac function: a study of monozygotic twins. Br Heart J 73(5):450–455. https://doi.org/10.1136/hrt.73.5.450 CrossRefPubMedPubMedCentral

32.

Raev DC (1994) Which left ventricular function is impaired earlier in the evolution of diabetic cardiomyopathy? An echocardiographic study of young type I diabetic patients. Diabetes Care 17(7):633–639. https://doi.org/10.2337/diacare.17.7.633 CrossRefPubMed

33.

Zarich SW, Arbuckle BE, Cohen LR, Roberts M, Nesto RW (1988) Diastolic abnormalities in young asymptomatic diabetic patients assessed by pulsed Doppler echocardiography. J Am Coll Cardiol 12(1):114–120. https://doi.org/10.1016/0735-1097(88)90364-6 CrossRefPubMed

34.

Karamitsos TD, Karvounis HI, Didangelos T, Parcharidis GE, Karamitsos DT (2008) Impact of autonomic neuropathy on left ventricular function in normotensive type 1 diabetic patients: a tissue Doppler echocardiographic study. Diabetes Care 31(2):325–327. https://doi.org/10.2337/dc07-1634 CrossRefPubMed

35.

Fang ZY, Yuda S, Anderson V, Short L, Case C, Marwick TH (2003) Echocardiographic detection of early diabetic myocardial disease. J Am Coll Cardiol 41(4):611–617. https://doi.org/10.1016/S0735-1097(02)02869-3 CrossRefPubMed

36.

Guha A, Harmancey R, Taegtmeyer H (2008) Nonischemic heart failure in diabetes mellitus. Curr Opin Cardiol 23(3):241–248. https://doi.org/10.1097/HCO.0b013e3282fcc2fa CrossRefPubMedPubMedCentral

37.

Cook N (2008) Statistical evaluation of prognostic versus diagnostic models: beyond the ROC curve. Clin Chem 54:17–23CrossRef

Titel: Echocardiography improves prediction of major adverse cardiovascular events in a population with type 1 diabetes and without known heart disease: the Thousand & 1 Study
verfasst von: Magnus T. Jensen
Peter Sogaard
Ida Gustafsson
Jan Bech
Thomas F. Hansen
Thomas Almdal
Simone Theilade
Tor Biering-Sørensen
Peter G. Jørgensen
Søren Galatius
Henrik U. Andersen
Peter Rossing
Publikationsdatum: 30.10.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Diabetologia / Ausgabe 12/2019
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-019-05009-2

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