Peter G Jørgensen1, Tor Biering-Sørensen1, Rasmus Mogelvang1, Thomas Fritz-Hansen1, Tina Vilsbøll2,3, Peter Rossing2,3, Magnus T Jensen1. 1. Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Hellerup DK, Denmark. 2. Steno Diabetes Center Copenhagen, University of Copenhagen, Niels Steensens Vej 2, Gentofte DK, Denmark. 3. Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen DK, Denmark.
Abstract
AIMS: Echocardiography is suggested in the diagnostic work-up of patients with Type 2 diabetes (T2D). We investigated which echocardiographic parameters that best predicted cardiovascular disease (CVD) and whether this was persistent in both genders in a large cohort of outpatients with T2D. METHODS AND RESULTS: We performed comprehensive echocardiography in 933 patients with T2D followed at specialized out-patients clinics in Copenhagen, Denmark. Follow-up was performed using national registries and included admission with future CVD events and non-CVD death as competing risk. Median follow-up was 4.8 years and 138 CVD events occurred. In univariable and multivariable analyses, a wide range of structural, diastolic, and systolic measurements predicted CVD including mean E/e' [hazard ratio (HR) 1.06, 95% confidence interval: (1.03-1.10), P < 0.001, C-statistics 0.74 (0.70-0.78)] and global longitudinal strain (GLS) [1.10 (1.01-1.20), P = 0.03, C-statistics 0.73 (0.69-0.77)]. However, this was modified by gender. In men, mean E/e' remained the strongest predictor in multivariable analyses and performed best measured by highest C-statistics [HR 1.15, 95% confidence interval: (1.08-1.21), P < 0.001, C-statistics 0.75 (0.71-0.80)] whereas in women this was GLS [1.39 (1.14-1.70), P = 0.001, C-statistics 0.79 (0.70-0.87)]. These findings persisted when excluding patients with known heart disease and when regarding all-cause mortality as a competing risk. CONCLUSION: A range of echocardiographic parameters predicted CVD in patients with Type 2 diabetes, however, in multivariable analyses, mean E/e' was the strongest predictor and had the highest model performance. Importantly, this study identifies a hitherto undescribed gender interaction as mean E/e' performed best in men, whereas in women this was GLS. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Echocardiography is suggested in the diagnostic work-up of patients with Type 2 diabetes (T2D). We investigated which echocardiographic parameters that best predicted cardiovascular disease (CVD) and whether this was persistent in both genders in a large cohort of outpatients with T2D. METHODS AND RESULTS: We performed comprehensive echocardiography in 933 patients with T2D followed at specialized out-patients clinics in Copenhagen, Denmark. Follow-up was performed using national registries and included admission with future CVD events and non-CVD death as competing risk. Median follow-up was 4.8 years and 138 CVD events occurred. In univariable and multivariable analyses, a wide range of structural, diastolic, and systolic measurements predicted CVD including mean E/e' [hazard ratio (HR) 1.06, 95% confidence interval: (1.03-1.10), P < 0.001, C-statistics 0.74 (0.70-0.78)] and global longitudinal strain (GLS) [1.10 (1.01-1.20), P = 0.03, C-statistics 0.73 (0.69-0.77)]. However, this was modified by gender. In men, mean E/e' remained the strongest predictor in multivariable analyses and performed best measured by highest C-statistics [HR 1.15, 95% confidence interval: (1.08-1.21), P < 0.001, C-statistics 0.75 (0.71-0.80)] whereas in women this was GLS [1.39 (1.14-1.70), P = 0.001, C-statistics 0.79 (0.70-0.87)]. These findings persisted when excluding patients with known heart disease and when regarding all-cause mortality as a competing risk. CONCLUSION: A range of echocardiographic parameters predicted CVD in patients with Type 2 diabetes, however, in multivariable analyses, mean E/e' was the strongest predictor and had the highest model performance. Importantly, this study identifies a hitherto undescribed gender interaction as mean E/e' performed best in men, whereas in women this was GLS. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Regitse H Christensen; Bernt Johan von Scholten; Christian S Hansen; Magnus T Jensen; Tina Vilsbøll; Peter Rossing; Peter G Jørgensen Journal: Cardiovasc Diabetol Date: 2019-08-30 Impact factor: 9.951
Authors: Jesper Jensen; Morten Schou; Caroline Kistorp; Jens Faber; Tine W Hansen; Magnus T Jensen; Henrik U Andersen; Peter Rossing; Tina Vilsbøll; Peter G Jørgensen Journal: Cardiovasc Diabetol Date: 2020-10-16 Impact factor: 9.951
Authors: Magnus T Jensen; Kenneth Fung; Nay Aung; Mihir M Sanghvi; Sucharitha Chadalavada; Jose M Paiva; Mohammed Y Khanji; Martina C de Knegt; Elena Lukaschuk; Aaron M Lee; Ahmet Barutcu; Edd Maclean; Valentina Carapella; Jackie Cooper; Alistair Young; Stefan K Piechnik; Stefan Neubauer; Steffen E Petersen Journal: Circ Cardiovasc Imaging Date: 2019-09-16 Impact factor: 7.792