Predictors of Late Heart Failure 7-9 Years After Baseline Cardiac CT Angiography in an Asymptomatic Type 2 Diabetic Cohort
Background:
Heart failure (HF) often complicates diabetes mellitus leading to severe disability and poor prognosis. Prospective information regarding risk of HF in asymptomatic diabetics and the role of coronary artery disease (CAD) in its pathogenesis is limited.
Aims:
We aimed to identify, in a cohort of asymptomatic type 2 diabetics, individuals at risk of developing late HF, in particular in relation to baseline extent of CAD.
Methods:
Baseline cardiac CT angiography (CTA) was performed in 735 diabetics aged 55-74 years (51.2% women) with no history of CAD and serum creatinine
Results:
HF-CVD occurred in 41 of 735 subjects (5.6%) and in 31/600 (5.2%) with full CTA data. HF occurred mostly in subjects without prior myocardial infarction (19/23, 82.6%).
Baseline univariate predictors of HF-CVD
|
Variable |
HF-CVD (N=41) |
No HF-CVD (N=694) |
p-value |
|
Duration DM (yrs) |
13.5±9.6 |
9.9±7.4 |
.004 |
|
Baseline systolic BP |
148.6±21.1 |
137.7±19.0 |
.0004 |
|
Albuminuria |
23 (56.1) |
112 (16.1) |
<.0001 |
|
HbA1c |
8.5±2.0 |
7.4±1.5 |
<.0001 |
|
CAC score |
148 (40, 490) |
55 (1, 324) |
.004 |
|
Left/right atrial volume >1 |
22 (71.0) |
187 (32.9) |
<.0001 |
|
Total coronary plaque volume |
241 (80, 648) |
139 (22, 411) |
.050 |
Independent baseline predictors of HF-CVD were left/right atrial volume >1 (p<.0001), microvascular disease (p<.0001) and systolic blood pressure (p=.035)(model C-statistic 0.792 (95%CI .758-.824).
Conclusions:
In asymptomatic diabetics followed for 7-9 years: 1. HF-CVD was infrequent. 2. Baseline left/right atrial volume, microvascular disease and systolic hypertension but not CAD independently predicted HF-CVD.
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