Echocardiographic phenotypes of T2DM patients show distinct clinical profiles
There are three different echocardiographic phenotypes of patients with type 2 diabetes mellitus (T2DM) based on cluster analysis of echocardiographic variables, according to a study. These phenotypes correlate with distinct clinical profiles and emphasize the prognostic value of left ventricular (LV) remodelling and subclinical dysfunction.
Researchers evaluated baseline echocardiography and a composite endpoint (cardiovascular mortality and hospitalization) in 842 T2DM patients from two prospective cohorts. They performed a cluster analysis on echocardiographic variables, and assessed the relationship between clusters and clinical profiles and outcomes.
A total of three clusters were identified. Patients in cluster 1 had the lowest LV mass index and ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) ratio, had the highest left ventricular ejection fraction (LVEF), and were predominantly male with the lowest rate of obesity or hypertension.
Those in cluster 2 had the highest strain and highest E/e’ ratio, were the oldest, were predominantly female, and had the lowest rate of isolated T2DM (without obesity or hypertension). Cluster 3 patients had the highest LV mass index and volumes and the lowest LVEF and strain, were predominantly male, and shared similar age and rate of obesity and hypertension as those in cluster 1.
The composite endpoint occurred in 56 of 521 patients (10.8 percent) after 67 months (range, 40 to 87) of follow-up. The outcome was similar between clusters 2 (hazard ratio [HR], 2.37; 95 percent CI, 1.15 to 4.88) and 3 (HR, 2.19; 1.00 to 4.82), which was worse than cluster 1.
“T2DM may alter cardiac structure and function, but obesity, hypertension or ageing can induce similar abnormalities,” researchers noted.