Global longitudinal strain and plasma biomarkers for prognosis in heart failure complicated by diabetes: a prospective observational study
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Published on: January 28, 2020
Nithin R Iyer1,2, Siew-Pang Chan3, Oi Wah Liew4
1National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.
Insights
Diabetes worsens heart failure prognosis, with cardiovascular magnetic resonance (CMR) global longitudinal strain (GLS) proving a key predictor in diabetic patients. This study highlights GLS as a vital prognostic marker for heart failure with diabetes.
Area of Science:
- Cardiology
- Diabetology
- Medical Imaging
Background:
- Heart failure (HF) and diabetes mellitus (DM) share a bidirectional relationship, with each condition negatively impacting the other's incidence and prognosis.
- The prognostic significance of global longitudinal strain (GLS), a measure derived from cardiovascular magnetic resonance (CMR), remains underexplored in patients with HF and co-existing DM.
Purpose of the Study:
- To investigate the prognostic value of GLS assessed by CMR in patients with heart failure, specifically examining the impact of diabetes.
- To compare CMR-derived markers and plasma biomarkers between HF patients with and without diabetes and assess their association with clinical outcomes.
Main Methods:
- A prospective, observational study involving 315 HF patients who underwent 3 Tesla CMR, including GLS, late gadolinium enhancement (LGE), native T1, and extracellular volume fraction (ECV) mapping.
- Measurement of plasma biomarkers: N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), growth differentiation factor 15 (GDF-15), soluble ST2 (sST2), and galectin 3 (Gal-3).
- Primary outcome defined as a composite of all-cause mortality or HF hospitalization.
Main Results:
- The diabetes group (n=159) exhibited higher LGE prevalence, native T1, and ECV compared to the non-diabetes group (n=156), indicating greater myocardial fibrosis.
- Patients with diabetes had significantly worse prognosis (Hazard Ratio [HR] 2.33; p<0.001) and elevated levels of all measured plasma biomarkers.
- In multivariable analysis within the diabetes group, both GLS (HR 1.12; p=0.01) and sST2 (HR 1.03; p=0.02) were independently associated with adverse outcomes.
Conclusions:
- Heart failure patients with diabetes demonstrate increased markers of myocardial fibrosis and a poorer prognosis compared to those without diabetes.
- Global longitudinal strain (GLS) measured by CMR is a powerful and independent prognostic indicator in heart failure patients with diabetes.
Background:
Heart failure (HF) and diabetes are associated with increased incidence and worse prognosis of each other. The prognostic value of global longitudinal strain (GLS) measured by cardiovascular magnetic resonance (CMR) has not been established in HF patients with diabetes.
Methods:
In this prospective, observational study, consecutive patients (n = 315) with HF underwent CMR at 3T, including GLS, late gadolinium enhancement (LGE), native T1, and extracellular volume fraction (ECV) mapping. Plasma biomarker concentrations were measured including: N-terminal pro B-type natriuretic peptide(NT-proBNP), high-sensitivity troponin T(hs-TnT), growth differentiation factor 15(GDF-15), soluble ST2(sST2), and galectin 3(Gal-3). The primary outcome was a composite of all-cause mortality or HF hospitalisation.
Results:
Compared to those without diabetes (n = 156), the diabetes group (n = 159) had a higher LGE prevalence (76 vs. 60%, p < 0.05), higher T1 (1285±42 vs. 1269±42ms, p < 0.001), and higher ECV (30.5±3.5 vs. 28.8±4.1%, p < 0.001). The diabetes group had higher NT-pro-BNP, hs-TnT, GDF-15, sST2, and Gal-3. Diabetes conferred worse prognosis (hazard ratio (HR) 2.33 [95% confidence interval (CI) 1.43-3.79], p < 0.001). In multivariable Cox regression analysis including clinical markers and plasma biomarkers, sST2 alone remained independently associated with the primary outcome (HR per 1 ng/mL 1.04 [95% CI 1.02-1.07], p = 0.001). In multivariable Cox regression models in the diabetes group, both GLS and sST2 remained prognostic (GLS: HR 1.12 [95% CI 1.03-1.21], p = 0.01; sST2: HR per 1 ng/mL 1.03 [95% CI 1.00-1.06], p = 0.02).
Conclusions:
Compared to HF patients without diabetes, those with diabetes have worse plasma and CMR markers of fibrosis and a more adverse prognosis. GLS by CMR is a powerful and independent prognostic marker in HF patients with diabetes.
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