ECG improves cardiovascular prognosis prediction in type 1 diabetes

Takeaway

• Echocardiography can non-invasively improve early detection of myocardial dysfunction and predict prognosis among individuals with type 1 diabetes (T1D) without known heart disease.

Why this matters

• Current guidelines do not include routine cardiovascular assessment.

Study design

• Prospective cohort of 1093 outpatients with T1D without known heart disease followed for average 7.5 years.
• Funding: None disclosed.

Key results

• Major adverse cardiovascular events (MACEs) occurred in 145 individuals.
• After multivariate adjustment, HR for MACE in impaired (<45%) vs preserved (≥45%) left ventricular ejection fraction (LVEF) was 3.93 (P<.001).
• Dose-response relationship found for E/e′ and MACE risk; HRs:
  • 1.59 (P=.031) moderately elevated E/e′ (8-12), and
  • 2.30 (P=.003) for high E/e′ (≥12).  
• HR for impaired (highest quartile by sex) vs preserved global longitudinal strain (GLS) was 1.65 (P=.005).
• Among the 1075 with preserved (≥45%) LVEF, relationships of E/e′ and GLS to MACE risk were similar to those of the whole population.
• Addition of echocardiography to validated Steno T1D Risk Engine significantly improved prognosis prediction.

Limitations

• Causes of death unknown.
• Echocardiographic definitions of myocardial dysfunction differ across labs.
• Findings require external validation.
• Study population may not represent all with T1D.