Abstract 4204: Impact of Left Ventricular Diastolic Functional Reserve on Clinical Outcome in Patients with Diabetes Mellitus
Left ventricular (LV) longitudinal diastolic functional reserve, assessed by the change of early diastolic mitral annular velocity (E′) during exercise, is abnormal in patients with diabetes without overt heart disease. However, its impact on clinical outcome has not been explored previously. We hypothesized that LV diastolic reserve could further stratify diastolic dysfunction, and have a prognostic significance in patients with diabetes. Of 1,170 patients who were referred for diastolic stress echocardiography, 227 consecutive patients (mean age 58 years, male 103, mean ejection fraction [EF] 68 %) with diabetes were identified. LV diastolic function reserve index (DFRI) was calculated as E′base x ΔE′; where ΔE′ is the change of E′ from baseline to exercise. The primary end-point was a composite of all-cause death and re-hospitalization for heart failure. The median follow-up duration was 34 months, and the primary end-point was occurred in 14 (6.1%) of 227 patients. Among the predictors that showed a significance in the univariate Cox analysis, including age, coronary artery disease history, renal insufficiency, LV mass index, LAVI, and EF, LV DFRI was the most independent predictor of adverse outcomes. When patients were classified by the median value of DFRI at 50W of exercise, patients with DFRI < 13.5 showed poorer clinical outcomes compared to those with DFRI ≥ 13.5 (p=0.001). The assessment of LV diastolic functional reserve using exercise Doppler echocardiography is helpful in further stratifying diastolic dysfunction, and provides incremental prognostic information in patients with diabetes without overt heart disease.