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Prognostic value of myocardial performance index in individuals with type 1 and type 2 diabetes: Thousand&1 and
Hashmat Sayed Zohori Bahrami1,2, Peter Godsk Jørgensen2,3, Jens Dahlgaard Hove1,4
1Department of Cardiology, Copenhagen University Hospital, Amager & Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark.
Insights
Myocardial performance index (MPI) predicts major adverse cardiovascular events (MACE) and heart failure in type 1 diabetes (T1D) but not type 2 diabetes (T2D). Echocardiographic assessment improves cardiovascular risk prediction in T1D.
Area of Science:
- Cardiology
- Diabetology
- Echocardiography
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality in type 1 (T1D) and type 2 diabetes (T2D).
- Current risk prediction models for diabetes lack myocardial function parameters.
- Myocardial performance index (MPI) reflects left ventricular function but its prognostic value in large diabetes populations is unevaluated.
Purpose of the Study:
- To evaluate the prognostic value of MPI in large cohorts of T1D and T2D.
- To assess if MPI improves cardiovascular risk prediction in diabetes.
Main Methods:
- Two prospective cohort studies (Thousand&1 for T1D, Thousand&2 for T2D) with 1093 and 1030 individuals respectively.
- Baseline clinical and echocardiographic data collected, with follow-up from national registries.
- Major adverse cardiovascular events (MACE) defined as acute coronary syndrome, heart failure, stroke, or all-cause mortality.
Main Results:
- MPI was independently associated with MACE (HR 1.2) and heart failure (HR 1.3) in T1D after adjustment.
- MPI did not show significant association with MACE or heart failure in T2D.
- MPI improved prediction of MACE and heart failure in T1D when added to the Steno T1 Risk Engine (AUC increased).
Conclusions:
- MPI is an independent predictor of MACE and heart failure in T1D, but not T2D.
- Echocardiographic assessment of MPI enhances cardiovascular risk prediction specifically in T1D.
- MPI may be a valuable tool for risk stratification in T1D patients.
Aims:
Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in type 1 (T1D) and type 2 diabetes (T2D). Despite diabetes affects the myocardium, risk prediction models do not include myocardial function parameters. Myocardial performance index (MPI) reflects left ventricular function. The prognostic value of MPI has not been evaluated in large-scale diabetes populations.
Methods And Results:
We evaluated two prospective cohort studies: Thousand&1 (1093 individuals with T1D) and Thousand&2 (1030 individuals with T2D). Clinical data, including echocardiography, were collected at baseline. We collected follow-up data from national registries. We defined major adverse cardiovascular events (MACE) as incident events of hospital admission for acute coronary syndrome, heart failure, stroke, or all-cause mortality. For included individuals (56% male, 54 ± 15 years, MPI 0.51 ± 0.1, 63% T1D), follow-up was 100% after median of 5.3 years (range: 4.8-6.3). MPI was associated with MACE (HR 1.2, 95%CI 1.0-1.3, P = 0.012, per 0.10-unit increase) and heart failure (HR 1.3, 95%CI 1.1-1.6, P = 0.005, per 0.10-unit increase) after adjusting for clinical and echocardiographic variables. MPI predicted MACE and heart failure better in T1D than T2D (P = 0.031 for interaction). MPI added discriminatory power to the Steno T1 Risk Engine, based on clinical characteristics, in predicting MACE [area under the curve (AUC) from 0.77 to 0.79, P = 0.030] and heart failure (AUC from 0.77 to 0.83, P = 0.009) in T1D.
Conclusion:
MPI is independently associated with MACE and heart failure in T1D but not T2D and improves prediction in T1D. Echocardiographic assessment in T1D may enhance risk prediction.
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