Abstract 13763: Usefulness of Echocardiography to Diagnose Diabetic Cardiomyopathy in Real World Practice

Introduction: Diabetic Cardiomyopathy (DbCM) is an underrecognized form of stage B heart failure (SBHF) which is associated with increased risk of overt heart failure (HF) in patients with type 2 diabetes (T2D). Two-dimensional echocardiography (2DE) can aid in identifying T2D patients with DbCM. This study aims to evaluate the usefulness of 2DE parameters for diagnosing DbCM. Hypothesis: Combination of echocardiographic features can help identify patients with DbCM. Methods: Retrospective review of medical records of T2D patients who had 2DE at UC San Diego Medical Center within 2016-2017 was conducted. Patients with DbCM were defined as T2D patients without overt HF and with echocardiographic demonstration of SBHF defined as left ventricular ejection fraction (LVEF) ≥45% and at least one of the following echocardiographic criteria: left atrial volume index (LAVI) ≥34 mL/m 2 , left ventricular mass index (LVMI) >95 g/m 2 in women and >115 g/m 2 in men, peak early mitral inflow velocity to early diastolic mitral annular velocity ratio (E/E’) ≥13, and right ventricular systolic pressure (RVSP) >35 mmHg, while excluding co-morbidities which can contribute to SBHF. Our study did not evaluate impaired longitudinal strain (GLS), an additional echocardiographic early indicator of SBHF and DbCM. Results: Out of 499 T2D patients who had 2DE, 454 (91%) had LVEF≥45%. Of them, 256 patients (56.4%) had at least one additional echocardiographic criterion, thus met criteria for SBHF. After excluding patients with overt HF, uncontrolled hypertension, coronary artery disease, valvular heart disease, or other cardiomyopathies, 14.8% of patients with SBHF met criteria for DbCM. Elevated LAVI, LVMI, E/E’ and RVSP were found in 63.2%, 26.3%, 44.7% and 34.2% of DbCM patients, respectively. Elevated LAVI and E/E’ occurred in 81.6% of DbCM patients, providing the most robust parameters for diagnosing DbCM. Conclusions: In T2D patients with preserved LVEF and probable DbCM, left atrial enlargement and elevated E/E’ are the most prevalent echocardiographic findings. The LAVI, E/E’, RVSP and LVMI, which are all readily detectable by 2DE, improve identification of patients at high-risk of developing overt HF in T2D patients with preserved LVEF in support of DbCM diagnosis.