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Incremental prognostic value of global longitudinal strain in patients with type 2 diabetes mellitus.
Cardiovasc Diabetol. 2016 Feb 03; 15:22.CD

Abstract

BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) are at high risk for cardiovascular events. The aim of the study was to assess whether global longitudinal strain (GLS) provides prognostic value in these patients.

METHODS

A total of 247 T2DM patients without history of cardiovascular complications and participated in the CDATS study were prospectively enrolled. Left ventricular (LV) systolic function was assessed by LV ejection fraction and speckle tracking derived LV systolic GLS. Diastolic function was assessed by E/E' ratio defined as the passive trans-mitral LV inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus. Cardiovascular event included acute coronary syndrome, cerebrovascular stroke, hospitalization for heart failure and cardiovascular death.

RESULTS

A total of 18 cardiovascular events occurred during a median follow-up duration of 33 months. Both E/E' ratio [hazard ratio (HR) 1.15, P < 0.01] and GLS (HR 1.39, P < 0.01) were independently associated with cardiovascular events. Importantly, GLS provided incremental prognostic information in addition to clinical data, HbA1c and E/E' ratio (Chi square 77.46, P = 0.04). Receiver-operator characteristic curve analysis demonstrated that E/E' ratio [area under curve (AUC) 0.66, P = 0.03] and GLS (AUC 0.72, P < 0.01) were strong predictors of cardiovascular events. Kaplan-Meier analysis showed that patients with E/E' > 13.6 or GLS > -17.9 % were associated with cardiovascular events. The presence of either a high E/E' ratio or an impaired GLS provides an excellent negative predictive value of cardiovascular events in these patients.

CONCLUSIONS

In T2DM patients with no history of cardiovascular disease, impaired GLS was associated with cardiovascular events and provided incremental prognostic value.

Authors+Show Affiliations

Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Rm 1929b, Block K, Hong Kong, China. juhualiu1984@163.com. Department of Medicine, Meishan People's Hospital, Meishan, Sichuan, China. juhualiu1984@163.com.Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Rm 1929b, Block K, Hong Kong, China. 2228057623@qq.com.Division of Endocrinology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China. 290505880@qq.com.Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Rm 1929b, Block K, Hong Kong, China. zhenzhe717@gmail.com.Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Rm 1929b, Block K, Hong Kong, China. 250937741@qq.com.Division of Endocrinology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China. 289991830@qq.com. Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China. 289991830@qq.com.Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Rm 1929b, Block K, Hong Kong, China. hftse@hkucc.hku.hk. Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China. hftse@hkucc.hku.hk. Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Hong Kong, China. hftse@hkucc.hku.hk.Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Rm 1929b, Block K, Hong Kong, China. khkyiu@hku.hk. Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China. khkyiu@hku.hk. Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Hong Kong, China. khkyiu@hku.hk.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26842466

Citation

Liu, Ju-Hua, et al. "Incremental Prognostic Value of Global Longitudinal Strain in Patients With Type 2 Diabetes Mellitus." Cardiovascular Diabetology, vol. 15, 2016, p. 22.
Liu JH, Chen Y, Yuen M, et al. Incremental prognostic value of global longitudinal strain in patients with type 2 diabetes mellitus. Cardiovasc Diabetol. 2016;15:22.
Liu, J. H., Chen, Y., Yuen, M., Zhen, Z., Chan, C. W., Lam, K. S., Tse, H. F., & Yiu, K. H. (2016). Incremental prognostic value of global longitudinal strain in patients with type 2 diabetes mellitus. Cardiovascular Diabetology, 15, 22. https://doi.org/10.1186/s12933-016-0333-5
Liu JH, et al. Incremental Prognostic Value of Global Longitudinal Strain in Patients With Type 2 Diabetes Mellitus. Cardiovasc Diabetol. 2016 Feb 3;15:22. PubMed PMID: 26842466.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incremental prognostic value of global longitudinal strain in patients with type 2 diabetes mellitus. AU - Liu,Ju-Hua, AU - Chen,Yan, AU - Yuen,Michele, AU - Zhen,Zhe, AU - Chan,Carmen Wing-Sze, AU - Lam,Karen Siu-Ling, AU - Tse,Hung-Fat, AU - Yiu,Kai-Hang, Y1 - 2016/02/03/ PY - 2015/11/11/received PY - 2016/01/08/accepted PY - 2016/2/5/entrez PY - 2016/2/5/pubmed PY - 2016/10/12/medline SP - 22 EP - 22 JF - Cardiovascular diabetology JO - Cardiovasc Diabetol VL - 15 N2 - BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) are at high risk for cardiovascular events. The aim of the study was to assess whether global longitudinal strain (GLS) provides prognostic value in these patients. METHODS: A total of 247 T2DM patients without history of cardiovascular complications and participated in the CDATS study were prospectively enrolled. Left ventricular (LV) systolic function was assessed by LV ejection fraction and speckle tracking derived LV systolic GLS. Diastolic function was assessed by E/E' ratio defined as the passive trans-mitral LV inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus. Cardiovascular event included acute coronary syndrome, cerebrovascular stroke, hospitalization for heart failure and cardiovascular death. RESULTS: A total of 18 cardiovascular events occurred during a median follow-up duration of 33 months. Both E/E' ratio [hazard ratio (HR) 1.15, P < 0.01] and GLS (HR 1.39, P < 0.01) were independently associated with cardiovascular events. Importantly, GLS provided incremental prognostic information in addition to clinical data, HbA1c and E/E' ratio (Chi square 77.46, P = 0.04). Receiver-operator characteristic curve analysis demonstrated that E/E' ratio [area under curve (AUC) 0.66, P = 0.03] and GLS (AUC 0.72, P < 0.01) were strong predictors of cardiovascular events. Kaplan-Meier analysis showed that patients with E/E' > 13.6 or GLS > -17.9 % were associated with cardiovascular events. The presence of either a high E/E' ratio or an impaired GLS provides an excellent negative predictive value of cardiovascular events in these patients. CONCLUSIONS: In T2DM patients with no history of cardiovascular disease, impaired GLS was associated with cardiovascular events and provided incremental prognostic value. SN - 1475-2840 UR - https://www.unboundmedicine.com/medline/citation/26842466/Incremental_prognostic_value_of_global_longitudinal_strain_in_patients_with_type_2_diabetes_mellitus_ L2 - https://cardiab.biomedcentral.com/articles/10.1186/s12933-016-0333-5 DB - PRIME DP - Unbound Medicine ER -