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J Am Coll Cardiol. 2017 Oct 3;70(14):1704-1716. doi: 10.1016/j.jacc.2017.07.792.

Clinical Implications of Echocardiographic Phenotypes of Patients With Diabetes Mellitus.

Author information

1
Physiology Department, DHU Ageing-Thorax-Vessel-Blood, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France; INSERM U955, Team08, Université Paris-Est Créteil (UPEC), Créteil, France.
2
Biostatistics Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France; CEpiA EA7376, DHU Ageing-Thorax-Vessel-Blood, Université Paris Est (UPEC), Créteil, France.
3
Cardiology Department, Cleveland Clinic, Cleveland, Ohio.
4
Centre d'Investigation Clinique INSERM 1407 Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France.
5
INSERM U955, Team08, Université Paris-Est Créteil (UPEC), Créteil, France.
6
Physiology Department, DHU Ageing-Thorax-Vessel-Blood, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France.
7
Service d'Explorations Fonctionnelles Cardiovasculaires, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France; INSERM UMR-1060, CarMeN Laboratory, Université Claude Bernard Lyon, Lyon, France.
8
INSERM UMR-1060, CarMeN Laboratory, Université Claude Bernard Lyon, Lyon, France; Fédération d'endocrinologie, Hospices Civils de Lyon, Bron, France.
9
Baker Heart and Diabetes Institute, Melbourne, Australia.
10
Physiology Department, DHU Ageing-Thorax-Vessel-Blood, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France; INSERM U955, Team08, Université Paris-Est Créteil (UPEC), Créteil, France. Electronic address: gderumeaux@gmail.com.

Abstract

BACKGROUND:

Type 2 diabetes mellitus (T2DM) may alter cardiac structure and function, but obesity, hypertension (HTN), or aging can induce similar abnormalities.

OBJECTIVES:

This study sought to link cardiac phenotypes in T2DM patients with clinical profiles and outcomes using cluster analysis.

METHODS:

Baseline echocardiography and a composite endpoint (cardiovascular mortality and hospitalization) were evaluated in 842 T2DM patients from 2 prospective cohorts. A cluster analysis was performed on echocardiographic variables, and the association between clusters and clinical profiles and outcomes was assessed.

RESULTS:

Three clusters were identified. Cluster 1 patients had the lowest left ventricular (LV) mass index and ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') ratio, had the highest left ventricular ejection fraction (LVEF), and were predominantly male with the lowest rate of obesity or HTN. Cluster 2 patients had the highest strain and highest E/e' ratio, were the oldest, were predominantly female, and had the lowest rate of isolated T2DM (without HTN or obesity). Cluster 3 patients had the highest LV mass index and volumes and the lowest LVEF and strain, were predominantly male, and shared similar age and rate of obesity and HTN as cluster 1 patients. After follow-up of 67 months (interquartile range: 40 to 87), the composite endpoint occurred in 56 of 521 patients (10.8%). Clusters 2 (hazard ratio: 2.37; 95% confidence interval: 1.15 to 4.88) and 3 (hazard ratio: 2.19; 95% confidence interval: 1.00 to 4.82) had a similar outcome, which was worse than cluster 1.

CONCLUSIONS:

Cluster analysis of echocardiographic variables identified 3 different echocardiographic phenotypes of T2DM patients that were associated with distinct clinical profiles and highlighted the prognostic value of LV remodeling and subclinical dysfunction.

KEYWORDS:

diabetic cardiomyopathy; diabetic heart disease; myocardial strain; prognosis; subclinical myocardial disease

PMID:
28958326
DOI:
10.1016/j.jacc.2017.07.792
[Indexed for MEDLINE]
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