P2636Stage B predictors of non-ischemic heart failure in type 2 diabetes mellitus
Abstract Purpose Stage B heart failure (SBHF), defined as LV hypertrophy (LVH) and impaired ejection fraction (EF), is precursor of reduced (HFrEF), mid-range (HFmrEF) or preserved (HFpEF) heart failure in type 2 diabetes mellitus (T2DM). Left atrial enlargement (LAE) and left ventricular diastolic or systolic dysfunction (assessed with tissue doppler and speckle-tracking echocardiography) are not accepted as HF stage B equivalents. Methods 396 consecutive community-based elderly (≥65 years) patients (pts) with asymptomatic T2DM (age 76±4 years; 64% women) with preserved EF (≥40%) and no atrial fibrillation, ischemic or valvular heart disease referred to echolab and prospectively followed from January 2015 by regional cardiologist. Results Prevalence of SBHF was observed in 6% after 2 years (EF≤40%) and LVH have 13% at baseline and 20% pts after 2 years. Left atrial enlargement (>34 ml/m2) occurs in 31%, resp. 48% pts after 24 months, diastolic dysfunction (E/e' >14) in 42%, resp. 68%. Systolic dysfunction (S' ≤6.0 cm/s) was observed in 20%, resp. 33% pts, and reduced global longitudinal (GLS <16%) in 23%, resp. 40% pts (all p<0.001). After a mean follow-up of 31±4 months developed new HF 19% pts (1% HFrEF, 6% HFmrEF and 12% HFpEF). The strongest predictors of incident HFpEF were older age (15%, 45% among men and 20%, 60% among women ages 65–74, and 75–85 years, p<0.001), new-onset atrial fibrillation: hazard ratio (HR) 1.4, p<0.01, and NTproBNP >125 pg/ml (HR 2,8, p<0.001). Significant (p<0.001) echocardiografic predictors of incident HFpEF were LVH (HR 2.90), systolic dysfunction (S' ≤6.0 cm/s, HR 2.2) and reduced GLS (HR 2.38). But not abnormal E/e' and LAE were associated with incident HF. Conclusions New echocardiographic parameters are useful in prediction of incident HF and should be added to standard SBHF criteria in asymptomatic patients with type 2 diabetes mellitus. Additional research is needed to update HF screening guidelines. Acknowledgement/Funding Supported by grant from the Slovak Society of Cardiology 2015 Selective screening of heart failure stages in regional settings