Strategy to identify subjects with diabetes mellitus more suitable for selective echocardiographic screening: The DAVID-Berg study.

Published

Journal Article

Despite the burden of pre-clinical heart failure (HF) among diabetes mellitus (DM) patients, routine screening echocardiography is not currently recommended. We prospectively assessed risk prediction for HF/death of a screening strategy combining clinical data, electrocardiogram, NTproBNP, and echocardiogram, aiming to identify DM patients more suitable for selective echocardiography.Among 4047 screened subjects aged≥55/≤80years, the DAVID-Berg Study prospectively enrolled 623 outpatients with DM, or hypertension, or known cardiovascular disease but with no HF history/symptoms. The present analysis focuses on data obtained during a longitudinal follow-up of the 219 patients with DM.Mean age was 68years, 61% were men, and median DM duration was 4.9years. During a median follow-up of 5.2years, 50 subjects developed HF or died. A predictive model using clinical data demonstrated moderate predictive power, which significantly improved by adding electrocardiogram (C-statistic 0.75 versus 0.70; p<0.05), but not NTproBNP (C-statistic 0.72, p=0.20). Subjects with normal clinical variables or abnormal clinical variables but normal electrocardiogram had low events rate (1.3 versus 2.4events/100-person-years, p=NS). Conversely, subjects with both clinical and electrocardiogram abnormalities (47%) carried higher risk (9.0events/100-person-years, p<0.001). The predictive power for mortality/HF development increased when echocardiography was added (13.6events/100-person-years, C-statistic 0.80, p<0.05).Our prospective study found that a selective echocardiographic screening strategy guided by abnormal clinical/electrocardiogram data can reliably identify DM subjects at higher risk for incident HF and death. This screening approach may hold promise in guiding HF prevention efforts among DM patients.

Full Text

Duke Authors

Cited Authors

  • Gori, M; Canova, P; Calabrese, A; Cioffi, G; Trevisan, R; De Maria, R; Grosu, A; Iacovoni, A; Fontana, A; Ferrari, P; Greene, SJ; Gheorghiade, M; Parati, G; Gavazzi, A; Senni, M

Published Date

  • December 2017

Published In

Volume / Issue

  • 248 /

Start / End Page

  • 414 - 420

PubMed ID

  • 28709699

Pubmed Central ID

  • 28709699

Electronic International Standard Serial Number (EISSN)

  • 1874-1754

International Standard Serial Number (ISSN)

  • 0167-5273

Digital Object Identifier (DOI)

  • 10.1016/j.ijcard.2017.06.101

Language

  • eng