Diastolic dysfunction in patients with diabetes linked to HF, increased mortality risk

Patients with diabetes who had preclinical diastolic dysfunction were more likely to develop HF and had an increased risk for mortality, according to results of a population-based study.

Researchers enrolled 1,760 patients with diabetes. The researchers defined diastolic dysfunction as passive transmitral left ventricular inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling ratio (E/e’)>15. The primary outcome of interest was the development of HF.

According to the study results, 411 (23%) patients had preclinical diastolic dysfunction without a diagnosis of HF, and 1,349 did not have diastolic dysfunction. Patients with both diabetes and diastolic dysfunction tended to be older, were more often female and had a higher prevalence of hypertension and coronary artery disease vs. those with diabetes who did not have diastolic dysfunction.

Using Cox proportional hazard modeling, the researchers reported that the E/e’ ratio was associated with the subsequent development of HF after adjusting for age, BMI, sex, hypertension, coronary disease, left atrial volume, ejection fraction, deceleration time and LV mass index. Their results suggested that for every one-unit increase in the mitral E/e’ ratio, the risk for developing HF increased by 3% (HR=1.03; 95% CI, 1.01-1.06). In Kaplan-Meyer analysis, E/e’ ratio>15 was predictive of HF.

The probability of developing HF in patients with diabetes who had diastolic dysfunction was 13.1% at one year and 36.9% at five years vs. 5.2% at one year and 16.8% at five years for patients with diabetes without diastolic dysfunction (P<.001). Results from a multivariable Cox proportional hazard regression analysis suggested that diastolic dysfunction was associated with the development of HF after adjustment for age, BMI, sex, hypertension, coronary disease, left atrial volume, ejection fraction, deceleration time and LV mass index (HR=1.61; 95% CI; 1.17-2.20).

Diastolic dysfunction was also predictive of death in Kaplan-Meier analysis. The researchers reported that the cumulative probability of death for patients with diabetes and diastolic dysfunction was 6.9% at one year and 30.8% at five years vs. 3.1% at one year and 12.1% at five years in patients with diabetes but without diastolic dysfunction (P<.001). Diastolic dysfunction was associated with death following adjustment for age, BMI, sex, hypertension, coronary disease, left atrial volume, ejection fraction, deceleration time and LV mass index (HR=2.01; 95% CI; 1.32-3.06).

Diastolic dysfunction was also associated with the subsequent development of atrial fibrillation in a subgroup of patients with no previous diagnosis of AF. According to the study results, the cumulative probability of subsequent AF in patients with diabetes and diastolic dysfunction was 6.8% at one year and 18.7% at five years, compared with 3.1% at one year and 8.8% at five years in patients with diabetes but without diastolic dysfunction (P<.001).

“This study confirms that preclinical diastolic dysfunction is prevalent in patients with diabetes,” the researchers wrote in their conclusion. “More importantly, we demonstrated that an increase in the E/e’ ratio in diabetic patients was associated with subsequent HF and mortality independent of hypertension, coronary disease and other echocardiographic parameters.”

From A. J Am Coll Cardiol. 2010;55:300-305.