Abstract
Aims
The ratio of early mitral inflow velocity to global diastolic strain rate (E/e′sr) has recently emerged as a novel measure of left ventricular filling pressure. E/e′sr has in previous studies demonstrated to have good prognostic value in various patient populations. The aim of this study is to investigate the prognostic value of E/e′sr in a large cohort of patients with Type 2 diabetes in relation to cardiovascular morbidity and mortality.
Methods and results
In this prospective study, 848 Type 2 diabetic patients (mean age 63.6 ± 10.3 years, 64.7% male) underwent comprehensive echocardiographic examination including 2D speckle tracking in which E/e′sr along with novel and conventional echocardiographic variables were obtained. During follow-up (median: 4.8 years, interquartile range: 4.0–5.3), 122 (14.1%) met the composite outcome of cardiovascular disease, hospitalization, and mortality. Both E/e′sr and E/e′ were significantly associated with the outcome [E/e′sr: hazard ratio (HR) 1.07, 95% confidence interval (CI): 1.05–1.10; P < 0.001, per 0.10 m increase] and (E/e′: HR 1.07, 95% CI: 1.05–1.10; P = 0.001, per 1 unit increase). E/e′sr remained an independent predictor after multivariable adjustment for demographical, clinical, and echocardiographic parameters (HR 1.06, 95% CI: 1.01–1.12; P = 0.032, per 10 cm increase). The same was true for E/e′ (HR 1.09, 95% CI: 1.04–1.14; P < 0.001, per 1 unit increase). Additionally, E/e′sr provided incremental prognostic information beyond the UK ‘Prospective Diabetes Study risk engine’ 0.72 (0.68–0.77) vs. 0.74 (0.70–79), P = 0.040.
Conclusion
In patients with Type 2 diabetes, E/e′sr provides independent and incremental prognostic information regarding cardiovascular morbidity and mortality.
Comparative cardiovascular morbidity and mortality in patients taking different insulin regimens for type 2 diabetes: a systematic review
