Strategy to identify subjects with diabetes mellitus more suitable for selective echocardiographic screening: The
Mauro Gori1, Paolo Canova1, Alice Calabrese1
1CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy.
Insights
A new screening strategy using clinical data and electrocardiograms can identify diabetes patients at high risk for heart failure or death. This approach guides selective echocardiography for better prevention efforts.
Area of Science:
- Cardiology
- Endocrinology
- Preventive Medicine
Background:
- Pre-clinical heart failure (HF) poses a significant burden on diabetes mellitus (DM) patients.
- Routine screening echocardiography is not standard for DM patients despite this risk.
- There is a need for effective strategies to identify high-risk DM individuals for targeted interventions.
Purpose of the Study:
- To prospectively assess the risk prediction of a screening strategy for HF/death in DM patients.
- To identify DM patients who would benefit most from selective echocardiography.
- To evaluate a combined approach using clinical data, ECG, NTproBNP, and echocardiography.
Main Methods:
- The DAVID-Berg Study enrolled 219 outpatients with DM (aged 55-80) with no prior HF history.
- Data included clinical variables, electrocardiogram (ECG), NTproBNP, and echocardiography during longitudinal follow-up.
- A predictive model was developed and refined by adding different components.
Main Results:
- During a median 5.2-year follow-up, 50 patients developed HF or died.
- Clinical data plus ECG significantly improved HF/death prediction (C-statistic 0.75) compared to clinical data alone (0.70).
- Patients with both clinical and ECG abnormalities had a significantly higher event rate (9.0 events/100 person-years), and adding echocardiography further improved prediction (C-statistic 0.80).
Conclusions:
- A selective echocardiographic screening strategy guided by abnormal clinical and ECG data reliably identifies DM subjects at higher risk for HF and death.
- This screening approach shows promise for guiding heart failure prevention strategies in diabetes patients.
- Integrating clinical assessment and ECG can effectively stratify risk in DM patients, optimizing the use of echocardiography.
Background:
Despite the burden of pre-clinical heart failure (HF) among diabetes mellitus (DM) patients, routine screening echocardiography is not currently recommended. We prospectively assessed risk prediction for HF/death of a screening strategy combining clinical data, electrocardiogram, NTproBNP, and echocardiogram, aiming to identify DM patients more suitable for selective echocardiography.
Methods:
Among 4047 screened subjects aged≥55/≤80years, the DAVID-Berg Study prospectively enrolled 623 outpatients with DM, or hypertension, or known cardiovascular disease but with no HF history/symptoms. The present analysis focuses on data obtained during a longitudinal follow-up of the 219 patients with DM.
Results:
Mean age was 68years, 61% were men, and median DM duration was 4.9years. During a median follow-up of 5.2years, 50 subjects developed HF or died. A predictive model using clinical data demonstrated moderate predictive power, which significantly improved by adding electrocardiogram (C-statistic 0.75 versus 0.70; p<0.05), but not NTproBNP (C-statistic 0.72, p=0.20). Subjects with normal clinical variables or abnormal clinical variables but normal electrocardiogram had low events rate (1.3 versus 2.4events/100-person-years, p=NS). Conversely, subjects with both clinical and electrocardiogram abnormalities (47%) carried higher risk (9.0events/100-person-years, p<0.001). The predictive power for mortality/HF development increased when echocardiography was added (13.6events/100-person-years, C-statistic 0.80, p<0.05).
Conclusions:
Our prospective study found that a selective echocardiographic screening strategy guided by abnormal clinical/electrocardiogram data can reliably identify DM subjects at higher risk for incident HF and death. This screening approach may hold promise in guiding HF prevention efforts among DM patients.
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