Prevalence of systolic and diastolic dysfunction in patients with type 1 diabetes without known heart disease: the Thousand & 1 Study
Heart failure is one of the leading causes of mortality in type 1 diabetes. Early identification is vitally important. We sought to determine the prevalence and clinical characteristics associated with subclinical impaired systolic and diastolic function in type 1 diabetes patients without known heart disease.
In this cross-sectional examination of 1,093 type 1 diabetes patients without known heart disease, randomly selected from the Steno Diabetes Center, complete clinical and echocardiographic examinations were performed and analysed in uni- and multivariable regression models.
The mean (SD) age was 49.6 (15) years, 53% of participants were men, and the mean duration of diabetes was 25.5 (15) years. Overall, 15.5% (n = 169) of participants had grossly abnormal systolic or diastolic function, including 1.7% with left ventricular ejection fraction (LVEF) < 45% and 14.4% with evidence of long-standing diastolic dysfunction. In univariable models, clinical characteristics associated with abnormal myocardial function were: age (per 10 years), OR (95% CI) 2.1 (1.8, 2.4); diabetes duration (per 10 years), 1.7 (1.4, 1.9); systolic BP ≥ 140 mmHg, 2.7 (1.9, 3.8); diastolic BP ≥ 90 mmHg, 1.8 (1.0, 3.1); estimated (e)GFR < 60 ml min−1 1.73 m−2, 3.8 (2.5, 5.9); microalbuminuria, 2.0 (1.3, 3.0); macroalbuminuria, 5.9 (3.8, 9.3); proliferative retinopathy, 3.6 (2.3, 5.8); blindness, 10.1 (3.2, 31.6); and peripheral neuropathy, 3.8 (2.7, 5.3). In multivariable models only age (2.1 [1.7, 2.5]), female sex, (1.9 [1.2, 2.8]) and macroalbuminuria (5.2 [2.9, 10.3]) remained significantly associated with subclinical grossly abnormal myocardial function.
Subclinical myocardial dysfunction is a common finding in type 1 diabetes patients without known heart disease. Type 1 diabetes patients with albuminuria are at greatly increased risk of having subclinical abnormal myocardial function compared with patients without albuminuria. Echocardiography may be particularly warranted in patients with albuminuria.
KeywordsAlbuminuria Diabetes Diastolic dysfunction Echocardiography Heart disease Heart failure Prevention Systolic dysfunction Type 1 diabetes
Mitral atrial inflow velocity
Angiotensin-converting enzyme inhibitor
American Society of Echocardiography
Angiotensin II receptor antagonist
Mitral early inflow velocity
Early diastolic tissue Doppler velocity
European Association of Echocardiography
Estimated left ventricular filling pressure
Flemish study on Environment, Genes and Health Outcomes
Implantable cardioverter defibrillator
Left ventricular ejection fraction
Urinary albumin/creatinine ratio
We are indebted to the staff and patients of the Steno Diabetes Center for their participation and contribution to the Thousand & 1 Study.
The support for the Thousand & 1 Study has been provided by the European Foundation for the Study of Diabetes/Pfizer European Programme 2010 for Research into Cardiovascular Risk Reduction in Patients with Diabetes; and The Danish Heart Foundation (number12-04-R90-A3840-22725). Additional funding has been received from the Torben & Alice Frimodts Foundation, Carl & Ellen Hertz’ Legat til Dansk Læge-og Naturvidenskab and the Beckett Foundation.
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
MTJ was involved in the design of the study, the acquisition, analysis and interpretation of data and drafting the manuscript and gave final approval of the version to be published. PS, PR and JSJ were involved in the conception and design of the study and the acquisition and interpretation of data, revised the manuscript critically for important intellectual content and gave final approval of the version to be published. JSJ is responsible for the integrity of the work as a whole. HUA, JB and TFH made substantial contributions to the acquisition of data, revised the manuscript critically for important intellectual content and gave final approval of the version to be published. SG, PGJ, TB-S and RM made substantial contributions to the interpretation of data, revised the manuscript critically for important intellectual content and gave final approval of the version to be published.
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