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Diabetologia

, Volume 57, Issue 4, pp 672–680 | Cite as

Prevalence of systolic and diastolic dysfunction in patients with type 1 diabetes without known heart disease: the Thousand & 1 Study

  • Magnus T. JensenEmail author
  • Peter Sogaard
  • Henrik U. Andersen
  • Jan Bech
  • Thomas F. Hansen
  • Søren Galatius
  • Peter G. Jørgensen
  • Tor Biering-Sørensen
  • Rasmus Møgelvang
  • Peter Rossing
  • Jan S. Jensen
Article

Abstract

Aims/hypothesis

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.

Methods

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.

Results

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.

Conclusions/interpretation

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.

Keywords

Albuminuria Diabetes Diastolic dysfunction Echocardiography Heart disease Heart failure Prevention Systolic dysfunction Type 1 diabetes 

Abbreviations

A

Mitral atrial inflow velocity

ACE-I

Angiotensin-converting enzyme inhibitor

ASE

American Society of Echocardiography

ATII-A

Angiotensin II receptor antagonist

CVD

Cardiovascular disease

E

Mitral early inflow velocity

e′

Early diastolic tissue Doppler velocity

EAE

European Association of Echocardiography

E/e′

Estimated left ventricular filling pressure

eGFR

Estimated GFR

FLEMENGHO

Flemish study on Environment, Genes and Health Outcomes

ICD

Implantable cardioverter defibrillator

IQR

Interquartile range

LVEF

Left ventricular ejection fraction

uACR

Urinary albumin/creatinine ratio

uAER

Urinary AER

Notes

Acknowledgements

We are indebted to the staff and patients of the Steno Diabetes Center for their participation and contribution to the Thousand & 1 Study.

Funding

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.

Contribution statement

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.

Supplementary material

125_2014_3164_MOESM1_ESM.pdf (52 kb)
ESM Table 1 (PDF 51 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Magnus T. Jensen
    • 1
    • 2
    Email author
  • Peter Sogaard
    • 1
  • Henrik U. Andersen
    • 2
  • Jan Bech
    • 1
  • Thomas F. Hansen
    • 1
  • Søren Galatius
    • 1
  • Peter G. Jørgensen
    • 1
    • 3
  • Tor Biering-Sørensen
    • 1
  • Rasmus Møgelvang
    • 1
  • Peter Rossing
    • 2
    • 4
    • 5
  • Jan S. Jensen
    • 1
    • 3
  1. 1.Department of CardiologyCopenhagen University Hospital GentofteHellerupDenmark
  2. 2.Steno Diabetes CenterGentofteDenmark
  3. 3.Institute of Clinical Medicine, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
  4. 4.Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
  5. 5.Faculty of HealthUniversity of AarhusAarhusDenmark

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