Abstract 3107: The Development of Heart Failure in Diabetic Patients with Preclinical Diastolic Dysfunction: A Population Based Study
Studies have reported a high prevalence of preclinical diastolic dysfunction among patients with diabetes mellitus (DM). However there have been few studies to evaluate the outcomes of preclinical diastolic dysfunction in DM. The objective of our study is to determine if there is an association between diastolic dysfunction in DM patients and the subsequent development of heart failure (HF). We retrospectively identified all DM patients with a tissue Doppler assessment of diastolic function within the Olmsted County, MN population from September 2001 through June 2007. Patients with a diagnosis of HF prior to and within 30 days of the echocardiogram were excluded as were patients with severe mitral or aortic valve regurgitation. Diastolic dysfunction was defined as a Doppler mitral E/e′ ratio ≥ 15 as previously described. The main outcome was the development of HF. Overall, 1794 DM patients with a tissue Doppler echocardiographic assessment of diastolic function were identified and 431 patients (24%) had diastolic dysfunction as defined above. Average time from echocardiogram to HF or latest follow-up was 2.67 ± 1.70 years. Using multivariable Cox’s proportional hazard modeling we determined that for every 1 unit increase in the mitral E/e′ ratio, the hazard of HF increases by 4% (HR=1.04, 95% CI=1.02–1.05; p<0.001) and that diastolic dysfunction was associated with the subsequent development of HF after adjustment for age, sex, body mass index, hypertension, coronary disease, ejection fraction, left atrial volume and deceleration time (HR=1.67, 95% CI=1.27–2.23; p<0.001). The cumulative probability of development of HF for DM patients with diastolic dysfunction was 13.8% at 1 year and 37.0% at 5 years compared to 5.4% at 1 year and 17.1% at 5 years for patients without diastolic dysfunction (P<0.001). This study confirms that preclinical diastolic dysfunction (24%) is prevalent in DM patients. More importantly, we demonstrated that an increase in the E/e′ ratio in DM patients is associated with the subsequent development of HF independent of hypertension, coronary disease or other echocardiographic parameters.