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Diabetologia. 2019 Oct 30. doi: 10.1007/s00125-019-05009-2. [Epub ahead of print]

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

Author information

1
Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900, Hellerup, Denmark. magnustjensen@dadlnet.dk.
2
Steno Diabetes Center Copenhagen, Copenhagen, Denmark. magnustjensen@dadlnet.dk.
3
Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. magnustjensen@dadlnet.dk.
4
Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
5
Department of Cardiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
6
Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900, Hellerup, Denmark.
7
Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
8
Steno Diabetes Center Copenhagen, Copenhagen, Denmark.
9
Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.

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 HbA1c 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.

KEYWORDS:

Cardiovascular; Diabetes; Echocardiography; Heart disease; Prognosis; Type 1 diabetes

PMID:
31664481
DOI:
10.1007/s00125-019-05009-2

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