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

Mauro Gori, Paolo Canova, Alice Calabrese, Giovanni Cioffi, Roberto Trevisan, Renata De Maria, Aurelia Grosu, Attilio Iacovoni, Alessandra Fontana, Paola Ferrari, Stephen J. Greene, Mihai Gheorghiade, Gianfranco Parati, Antonello Gavazzi, Michele Senni*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background 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. Methods Among 4047 screened subjects aged ≥ 55/≤80 years, 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. Results Mean age was 68 years, 61% were men, and median DM duration was 4.9 years. During a median follow-up of 5.2 years, 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 2.4 events/100-person-years, p = NS). Conversely, subjects with both clinical and electrocardiogram abnormalities (47%) carried higher risk (9.0 events/100-person-years, p < 0.001). The predictive power for mortality/HF development increased when echocardiography was added (13.6 events/100-person-years, C-statistic 0.80, p < 0.05). Conclusions 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.

Original languageEnglish (US)
Pages (from-to)414-420
Number of pages7
JournalInternational Journal of Cardiology
Volume248
DOIs
StatePublished - Dec 1 2017

Keywords

  • Echocardiographic screening
  • Electrocardiogram
  • Heart failure
  • Long term follow-up
  • NTproBNP

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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