Philippe Sosner1, Charlotte Hulin-Delmotte2, Pierre-Jean Saulnier3, Séverin Cabasson4, Elise Gand5, Florence Torremocha5, Xavier Piguel5, Aurélie Miot6, Richard Maréchaud6, Daniel Herpin7, Stéphanie Ragot8, Samy Hadjadj9. 1. CHU de Poitiers, Cardiologie, Poitiers, France; Université de Poitiers, Laboratoire MOVE (EA6314), Poitiers, France; Centre médico-sportif Mon Stade, Paris, France. Electronic address: philippe.sosner@univ-poitiers.fr. 2. CHU de Poitiers, Physiologie, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France. 3. Université de Poitiers, CIC1402, Poitiers, France; CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France; Inserm, CIC1402, Poitiers, France. 4. CHU de Poitiers, Réanimation Médicale, Poitiers, France. 5. CHU de Poitiers, Endocrinologie, Poitiers, France. 6. Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; CHU de Poitiers, Endocrinologie, Poitiers, France. 7. CHU de Poitiers, Cardiologie, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France. 8. Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; Université de Poitiers, CIC1402, Poitiers, France; CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France; Inserm, CIC1402, Poitiers, France. 9. Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; Université de Poitiers, CIC1402, Poitiers, France; CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France; Inserm, CIC1402, Poitiers, France; CHU de Poitiers, Endocrinologie, Poitiers, France.
Abstract
BACKGROUND: Left ventricular hypertrophy (LVH) and kidney damage (abnormal urinary albumin-to-creatinine ratio [uACR] or estimated glomerular filtration rate [eGFR]) are predictive of major cardiovascular events (MACE) in patients with type 2 diabetes (T2D) but are rarely used in cardiovascular score calculators. Our study aimed to assess their respective prognostic values for MACE and the additive information they provide to score calculators. METHODS: A total of 1298 T2D (43% women) aged 65 (SD 11) years were followed up for a median of 65 months, with MACE as a primary composite end point: cardiovascular death, nonfatal myocardial infarction, or stroke. Electrocardiogram (ECG)-derived LVH was defined using Sokolow, Gubner, and Cornell product indexes; uACR was considered as abnormal if >2.5 mg/mmol in men or >3.5 mg/mmol in women and eGFR if <60 mL/min per 1.73 m(2). RESULTS: Urinary albumin-to-creatinine ratio was higher in subjects with electrocardiographic LVH (ECG-LVH) than in subjects without (median [interquartile range] 7.61 [43.48] and 2.56 [10.53], respectively; P < .0001). After adjustment for age, history of myocardial infarction, and peripheral artery disease, ECG-LVH and kidney damage were strong predictors for MACE (adjusted hazard ratio [1.64; 95% CI 1.23-2.20], [1.90; 95% CI 1.43-2.53], and [1.85; 95% CI 1.42-2.41] for ECG-LVH, uACR, and eGFR, respectively). Net reclassification improvement was higher with the model including both ECG-LVH and uACR than models with ECG-LVH alone (P < .0001) or uACR alone (P < .0001). In addition, using cardiovascular risk calculators (Framingham score and others), we observed an additional prognostic value of ECG-LVH for each one of them. CONCLUSIONS: Electrocardiographic LVH is complementary to kidney damage for MACE prediction in T2D.
BACKGROUND:Left ventricular hypertrophy (LVH) and kidney damage (abnormal urinary albumin-to-creatinine ratio [uACR] or estimated glomerular filtration rate [eGFR]) are predictive of major cardiovascular events (MACE) in patients with type 2 diabetes (T2D) but are rarely used in cardiovascular score calculators. Our study aimed to assess their respective prognostic values for MACE and the additive information they provide to score calculators. METHODS: A total of 1298 T2D (43% women) aged 65 (SD 11) years were followed up for a median of 65 months, with MACE as a primary composite end point: cardiovascular death, nonfatal myocardial infarction, or stroke. Electrocardiogram (ECG)-derived LVH was defined using Sokolow, Gubner, and Cornell product indexes; uACR was considered as abnormal if >2.5 mg/mmol in men or >3.5 mg/mmol in women and eGFR if <60 mL/min per 1.73 m(2). RESULTS: Urinary albumin-to-creatinine ratio was higher in subjects with electrocardiographic LVH (ECG-LVH) than in subjects without (median [interquartile range] 7.61 [43.48] and 2.56 [10.53], respectively; P < .0001). After adjustment for age, history of myocardial infarction, and peripheral artery disease, ECG-LVH and kidney damage were strong predictors for MACE (adjusted hazard ratio [1.64; 95% CI 1.23-2.20], [1.90; 95% CI 1.43-2.53], and [1.85; 95% CI 1.42-2.41] for ECG-LVH, uACR, and eGFR, respectively). Net reclassification improvement was higher with the model including both ECG-LVH and uACR than models with ECG-LVH alone (P < .0001) or uACR alone (P < .0001). In addition, using cardiovascular risk calculators (Framingham score and others), we observed an additional prognostic value of ECG-LVH for each one of them. CONCLUSIONS: Electrocardiographic LVH is complementary to kidney damage for MACE prediction in T2D.