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Echocardiography and inflammatory biomarkers for predicting mortality and major adverse cardiovascular events in type
Hashmat Sayed Zohori Bahrami1,2,3, Peter Godsk Jørgensen4, Jens Dahlgaard Hove5,6
1Department of Clinical and Translational Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark. sayed.hzb@gmail.com.
Insights
Combining echocardiography and inflammatory biomarkers significantly improves early risk detection for mortality and major adverse cardiovascular events (MACE) in type 1 diabetes patients. This approach offers enhanced prediction beyond existing clinical risk tools.
Area of Science:
- Cardiology
- Endocrinology
- Biomarkers
Background:
- Existing type 1 diabetes risk tools lack assessment of left ventricular dysfunction and inflammation.
- Early detection of cardiovascular risk in type 1 diabetes is crucial for preventing adverse outcomes.
Purpose of the Study:
- To evaluate the combined predictive value of echocardiography and inflammatory biomarkers for mortality and MACE in type 1 diabetes.
- To determine if subclinical left ventricular dysfunction and inflammation improve cardiovascular risk stratification.
Main Methods:
- Prospective cohort study of type 1 diabetes patients without known cardiovascular disease.
- Assessed subclinical left ventricular dysfunction (E/e' ratio, GLS) and inflammatory markers (IL-6, suPAR, hsCRP).
- Used Cox models, adjusted for Steno T1 Risk Engine variables, to assess associations with mortality and MACE. C-statistics and net reclassification improvement were calculated.
Main Results:
- Elevated E/e' combined with IL-6 or suPAR independently predicted mortality.
- The combination of E/e' and IL-6 or suPAR significantly improved risk prediction compared to the Steno T1 Risk Engine alone.
- Similar findings were observed for global longitudinal strain (GLS) and MACE as the outcome.
Conclusions:
- Echocardiography and inflammatory biomarkers synergistically identify high-risk individuals with type 1 diabetes.
- This combined approach enhances the early detection of mortality and MACE risk in asymptomatic patients.
- Integrating cardiac imaging and inflammatory markers offers a more comprehensive cardiovascular risk assessment strategy.
Background/Aims:
Current clinical risk tools in type 1 diabetes do not include left ventricular dysfunction or inflammation, potentially limiting early risk detection. We aimed to evaluate the associations and predictive value of combining echocardiography with inflammatory biomarkers for mortality and major adverse cardiovascular events (MACE).
Methods:
In a prospective cohort of individuals with type 1 diabetes without known cardiovascular disease, we evaluated whether subclinical left ventricular dysfunction, defined by an elevated ratio of early mitral inflow velocity to early diastolic mitral annular velocity (E/e') or impaired global longitudinal strain (GLS), combined with elevated levels of an inflammatory biomarker (interleukin-6 [IL-6], soluble urokinase-plasminogen-activator-receptor [suPAR], or high-sensitivity C-reactive-protein [hsCRP]), was associated with all-cause mortality and MACE. Cox models were adjusted for all 10 variables included in the Steno T1 Risk Engine variables: age, sex, systolic blood pressure, duration of diabetes, HbA1c, low-density lipoprotein, estimated glomerular filtration rate, albuminuria status, smoking, and physical activity. C-statistics and net reclassification improvement were assessed.
Results:
Among 876 participants (51% male, median age 50 years), 114 deaths occurred over 14.5 years of follow-up. Elevated E/e' combined with IL-6 or suPAR, but not hsCRP, was independently associated with mortality. Compared with individuals with E/e' <8 and non-elevated IL-6, the hazard ratio (HR) for E/e' 8-13 with elevated IL-6 was 2.5 (95% CI 1.4 to 4.6, P < 0.01), and for E/e' ≥13 with elevated IL-6 was 3.4 (1.5-7.6; P < 0.01). Corresponding HRs for suPAR were 2.4 (1.2 to 4.7, P < 0.01) and 3.9 (1.8 to 8.5, P < 0.01). Adding E/e' and an inflammatory biomarker increased the C-statistic from 0.839 (Steno T1 Risk Engine alone) to 0.887 (E/e' and IL6) and 0.868 (E/e' and suPAR). Findings were similar for GLS and with MACE as the outcome.
Conclusions:
Echocardiography combined with inflammatory biomarkers synergistically identifies individuals with type 1 diabetes, without known cardiovascular disease, who are at high risk of mortality and MACE.
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