Abstract 17729: Cumulative Effect of Echocardiographic Markers of Elevated Left Ventricular Filling Pressure on Future Cardiovascular Events in Subjects with Diabetes
Background: Type 2 diabetes mellitus (T2DM) is a strong and independent risk factor for the development of major adverse cardiovascular events (MACE). An elevated left ventricular filling pressure (LVFP) measured by various echocardiographic (echo) parameters is associated with poor outcomes. This study investigated the cumulative effect of various echo measures of elevated LVFP and the risk of MACE.
Methods: We prospectively recruited 1308 subjects (subs) (age 63.5± 11.7 years, 60% male) with T2DM attending a complications surveillance program at a single tertiary center (21 subs excluded due to inadequate echo imaging). Baseline resting echocardiogram was performed and subs were followed for a median of 4.4 years [interquartile range 3.2, 5.9]. Elevated LVFP was defined by the following echo measures: left atrial area > 20cm2, peak early diastolic (dia) mitral velocity (E) to peak mitral annular velocity ratio ≥ 10, pulmonary vein (PV) peak dia velocity > systolic velocity, peak PV atrial reversal >35cm/s, PV atrial reversal duration minus late dia mitral inflow wave duration >30msec and mitral E/A change >/= 0.5 with Valsalva. The primary outcome was MACE defined as hospitalization for acute coronary syndrome, stroke or heart failure, coronary or peripheral vessel revascularization or death.
Results: Over the follow-up period, 27% of subs experienced at least one MACE and 15% experienced heart failure or death. After adjusting for age, gender, presence of macrovascular complications and cardiovascular risk factors, each additional echo measure of elevated LVFP was associated with a 29% increased risk of MACE. After the same covariate adjustment, subs with >3 measures of elevated LVFP had a higher hazard ratio of 2.7 (95% CI 1.9-3.8, P<0.001) for MACE compared to subs with <2 measures of elevated LVFP.
Conclusions: Echo features of elevated LVFP predict future MACE. The presence of >3 features of elevated LVFP is associated with poorer outcomes in T2DM.
- © 2011 by American Heart Association, Inc.