427-P: The Prevalence of Asymptomatic Cardiac Dysfunction Diagnosed by Tissue Doppler Echocardiography in Subjects with Type 2 Diabetes

Background: The sodium-glucose transporter 2 inhibitors have been found to reduce the risk of hospitalization for heart failure (HF). However, in the majority of clinical studies of diabetes, HF is usually defined as administration to hospital with typical symptoms without measurements of cardiac-function using tissue Doppler echocardiography (TDE). Therefore, the incidence of cardiac-dysfunction in diabetic subjects would be underestimated, leading to a delay in the initiation of treatment. Thus, we analyzed the prevalence of asymptomatic cardiac-dysfunction (ACD) diagnosed by TDE in subjects with diabetes.

Methods: We recruited inpatients or outpatients with type 2 diabetes at university hospital. Subjects with symptomatic HF, atrial fibrillation, myocardial infarction, valvular disease, and hypertrophic cardiomyopathy were excluded from this study. Finally, 343 diabetic subjects were enrolled. Cardiac-dysfunction was defined as left ventricular ejection fraction <50% (systolic dysfunction) and/or the ratio of early transmitral flow velocity to TDE diastolic mitral annular velocity>15 (diastolic dysfunction). To determine optimum cut-off values for BNP and eGFR associated with ACD, we performed ROC curve analyses.

Results: Twenty-four % of subjects had ACD. Seventy-eight % of these subjects had diastolic dysfunction. Age, the proportion of females, pulse wave velocity and BNP were higher, and eGFR was lower in subjects with cardiac-dysfunction than those without cardiac-dysfunction. ROC curve analyses revealed that AUCROC for BNP was 0.66 with a sensitivity of 57% and a specificity of 70% at a cut-off value of 32 mg/gCr, and eGFR was 0.53 with a sensitivity of 74% and a specificity of 70% at a cut-off value of 62 mL/min/1.73m² (both p<0.001).

Conclusions: About a quarter of diabetic subjects had ACD, and the majority of them were diastolic dysfunction. Therefore, TDE would be needed to accurately assess ACD in subjects with diabetes.