Skip to main content

Advertisement

SpringerLink
Log in

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

  • Article
  • Published:
Diabetologia Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

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

References

  1. Soedamah-Muthu SS, Fuller JH, Mulnier HE et al (2006) High risk of cardiovascular disease in patients with type 1 diabetes in the U.K.: a cohort study using the general practice research database. Diabetes Care 29:798–804

    Article  PubMed  Google Scholar 

  2. Laing SP, Swerdlow AJ, Slater SD et al (2003) Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes. Diabetologia 46:760–765

    Article  CAS  PubMed  Google Scholar 

  3. Lind M, Bounias I, Olsson M et al (2011) Glycaemic control and incidence of heart failure in 20,985 patients with type 1 diabetes: an observational study. Lancet 378:140–146

    Article  PubMed  Google Scholar 

  4. Mogensen UM, Jensen T, Køber L et al (2012) Cardiovascular autonomic neuropathy and subclinical cardiovascular disease in normoalbuminuric type 1 diabetic patients. Diabetes 61:1822–1830

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Kim WY, Astrup AS, Stuber M et al (2007) Subclinical coronary and aortic atherosclerosis detected by magnetic resonance imaging in type 1 diabetes with and without diabetic nephropathy. Circulation 115:228–235

    Article  PubMed  Google Scholar 

  6. Sato A, Tarnow L, Parving HH (1999) Prevalence of left ventricular hypertrophy in Type I diabetic patients with diabetic nephropathy. Diabetologia 42:76–80

    Article  CAS  PubMed  Google Scholar 

  7. Sato A, Tarnow L, Parving HH (1998) Increased left ventricular mass in normotensive type 1 diabetic patients with diabetic nephropathy. Diabetes Care 21:1534–1539

    Article  CAS  PubMed  Google Scholar 

  8. Rubler S, Dlugash J, Yuceoglu YZ et al (1972) New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 30:595–602

    Article  CAS  PubMed  Google Scholar 

  9. Yazici D, Yavuz DG, Toprak A et al (2013) Impaired diastolic function and elevated Nt-proBNP levels in type 1 diabetic patients without overt cardiovascular disease. Acta Diabetol 50:155–161

    Article  CAS  PubMed  Google Scholar 

  10. Halley CM, Houghtaling PL, Khalil MK et al (2011) Mortality rate in patients with diastolic dysfunction and normal systolic function. Arch Intern Med 171:1082–1087

    Article  PubMed  Google Scholar 

  11. Fang ZY, Prins JB, Marwick TH (2004) Diabetic cardiomyopathy: evidence, mechanisms, and therapeutic implications. Endocr Rev 25:543–567

    Article  CAS  PubMed  Google Scholar 

  12. Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  13. Nagueh SF, Appleton CP, Gillebert TC et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 10:165–193

    Article  PubMed  Google Scholar 

  14. Unzek S, Popovic ZB, Marwick TH, Diastolic Guidelines Concordance Investigators (2011) Effect of recommendations on interobserver consistency of diastolic function evaluation. JACC Cardiovasc Imaging 4:460–467

    Article  PubMed  Google Scholar 

  15. Mantha S, Roizen MF, Fleisher LA et al (2000) Comparing methods of clinical measurement: reporting standards for Bland and Altman analysis. Anesth Analg 90:593–602

    Article  CAS  PubMed  Google Scholar 

  16. Levey AS, Bosch JP, Lewis JB et al (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470

    Article  CAS  PubMed  Google Scholar 

  17. Andersen AR, Christiansen JS, Andersen JK et al (1983) Diabetic nephropathy in type 1 (insulin-dependent) diabetes: an epidemiological study. Diabetologia 25:496–501

    Article  CAS  PubMed  Google Scholar 

  18. Redfield MM, Jacobsen SJ, Burnett JC Jr et al (2003) Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 289:194–202

    Article  PubMed  Google Scholar 

  19. Mogelvang R, Sogaard P, Pedersen SA et al (2009) Cardiac dysfunction assessed by echocardiographic tissue Doppler imaging is an independent predictor of mortality in the general population. Circulation 119:2679–2685

    Article  PubMed  Google Scholar 

  20. Davies M, Hobbs F, Davis R et al (2001) Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study. Lancet 358:439–444

    Article  CAS  PubMed  Google Scholar 

  21. Hillis GS, Møller JE, Pellikka PA et al (2004) Noninvasive estimation of left ventricular filling pressure by E/e′ is a powerful predictor of survival after acute myocardial infarction. J Am Coll Cardiol 43:360–367

    Article  PubMed  Google Scholar 

  22. Kuznetsova T, Herbots L, López B et al (2009) Prevalence of left ventricular diastolic dysfunction in a general population. Circ Heart Fail 2:105–112

    Article  PubMed  Google Scholar 

  23. From AM, Scott CG, Chen HH (2010) The development of heart failure in patients with diabetes mellitus and pre-clinical diastolic dysfunction a population-based study. J Am Coll Cardiol 55:300–305

    Article  PubMed  Google Scholar 

  24. Von Bibra H, St John Sutton M (2010) Diastolic dysfunction in diabetes and the metabolic syndrome: promising potential for diagnosis and prognosis. Diabetologia 53:1033–1045

    Article  Google Scholar 

  25. Di Bonito P, Moio N, Cavuto L et al (2005) Early detection of diabetic cardiomyopathy: usefulness of tissue Doppler imaging. Diabet Med J Br Diabet Assoc 22:1720–1725

    Article  Google Scholar 

  26. Salem M, El Behery S, Adly A et al (2009) Early predictors of myocardial disease in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 10:513–521

    Article  CAS  PubMed  Google Scholar 

  27. Gul K, Celebi AS, Kacmaz F et al (2009) Tissue Doppler imaging must be performed to detect early left ventricular dysfunction in patients with type 1 diabetes mellitus. Eur J Echocardiogr 10:841–846

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900, Hellerup, Denmark

    Magnus T. Jensen, Peter Sogaard, Jan Bech, Thomas F. Hansen, Søren Galatius, Peter G. Jørgensen, Tor Biering-Sørensen, Rasmus Møgelvang & Jan S. Jensen

  2. Steno Diabetes Center, Gentofte, Denmark

    Magnus T. Jensen, Henrik U. Andersen & Peter Rossing

  3. Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

    Peter G. Jørgensen & Jan S. Jensen

  4. Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

    Peter Rossing

  5. Faculty of Health, University of Aarhus, Aarhus, Denmark

    Peter Rossing

Authors
  1. Magnus T. Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Sogaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henrik U. Andersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Bech
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas F. Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Søren Galatius
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter G. Jørgensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tor Biering-Sørensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rasmus Møgelvang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Peter Rossing
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jan S. Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Magnus T. Jensen.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM Table 1

(PDF 51 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jensen, M.T., Sogaard, P., Andersen, H.U. et al. Prevalence of systolic and diastolic dysfunction in patients with type 1 diabetes without known heart disease: the Thousand & 1 Study. Diabetologia 57, 672–680 (2014). https://doi.org/10.1007/s00125-014-3164-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00125-014-3164-5

Keywords

Search

Navigation