Echocardiographic profiling could guide cardiovascular risk reduction in type 2 diabetes patients
medwireNews: Patients with type 2 diabetes can be divided into three groups with distinct clinical profiles based on echocardiographic measures, researchers report.
Geneviève Derumeaux (INSERM U955, Paris, France) and colleagues used cluster analysis to investigate the relationship between echocardiographic findings and clinical outcomes among 521 patients with type 2 diabetes and no overt heart disease at baseline, of whom 10.8% experienced the composite endpoint of cardiovascular mortality and hospitalization over a median 67 months of follow-up.
As reported in the Journal of the American College of Cardiology, the team identified three clusters of echocardiographic phenotypes, the first of which comprised predominantly male patients with the lowest rates of obesity and hypertension and the best prognosis.
Patients in this “low comorbidity cluster” had the lowest left ventricular mass indexed to body surface area (LVMi) and peak early diastolic velocity/mitral annular early diastolic velocity (E/e’) ratio values, the highest left ventricular ejection fraction (LVEF), and the second highest strain values.
Participants in the second group, the elderly/diastolic dysfunction cluster, had the highest strain values but the lowest e’ velocities and the highest E/e’ ratio of all the groups. These patients were older than those in the other clusters (median 60.0 years) and the majority (53%) were female, with the highest body mass index, blood pressure levels, and heart rates. Patients in the elderly/diastolic dysfunction cluster had a 2.37-fold increased risk for cardiovascular mortality or hospitalization compared with those in the low comorbidity cluster.
The third group (hypertrophic systolic dysfunction cluster), on the other hand, was predominantly (76.2%) male, and participants were of similar age and had comparable rates of obesity and hypertension as those in the low comorbidity cluster. These patients had the highest LVMi and LV volumes and the lowest LVEF and strain compared with the other groups. Compared with participants in the low comorbidity group, those in the hypertrophic systolic dysfunction cluster had a 2.19-fold higher risk for the composite cardiovascular endpoint.
Noting that these risk increases were similar after adjustment for age, sex, and diabetes duration, the researchers say that their findings “highlighted the prognostic value of LV remodeling and subclinical systolic dysfunction in [type 2 diabetes], despite similar clinical profiles of obesity and [hypertension].”
“This suggested that patients with low strain and/or increased LV mass might be suitable for targeted preventive strategies.”
Writing in a linked editorial comment, Maurizio Galderisi (Federico II University Hospital, Naples, Italy) and colleagues suggest that women in the elderly/diastolic dysfunction cluster “could be more susceptible to metabolic management” with sodium–glucose cotransporter-2 inhibitors or similar drug classes, “whereas treatment with drugs interacting with the renin-angiotensin-aldosterone system should be preferred” for men in the hypertrophic systolic dysfunction group.
And the commentators conclude that the study results “could therefore open new avenues for the design of mechanistic interventional trials with new classes of antidiabetic medications.”
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