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Editorial
DYDA study findings: HbA1c a potential predictive biomarker of cardiovascular events.
Prof Roberto Latini
Istituto Mario Negri
Dept Cardiovascular Research
Milano, Italy
The DYsfunction in DiAbetes (DYDA) study was a prospective, multicenter, national study evaluating the clinical and echocardiographic characteristics of a large series of individuals with type 2 diabetes mellitus without previous cardiac disease. The objective was to assess the prevalence of subclinical left ventricular dysfunction (LVD) and of possible early-stage determinants in diabetic patients without known cardiac disease, to design prevention strategies. The DYDA study was initiated in 2006 by the Italian Association of Clinical Cardiologist ANMCO together with the Italian Association of Clinical Diabetologists (AMD) and involved 37 diabetes care units. Among the 960 patients enrolled, LVD was found to be very common (isolated systolic LVD was detected in 22.0%, isolated diastolic LVD in 21.5%, combined systolic and diastolic LVD in 12.7%). After a follow-up of 2 years, any LVD was detectable in about 90% of patients with diabetes mellitus without evidence of cardiac disease, with older age and higher HbA1c as the strongest determinants. The only laboratory marker, among those tested (NT-proBNP, hsCRP and microalbuminuria) found to predict 2-year outcomes in these patients was HbA1c.
Levels of biomarkers by categories of LV dysfunction
|
NT-proBNP (ng/L) |
hsCRP (mg/L) |
UACR (mg/g) |
HbA1c (%) |
|
|
Isolated LV systolic dysfunction (n=151) |
38 [14-63] | 1.7 [0.9-4.7] | 11.7 [4.5-32.3] | 6.7 [6.1-7.9] |
|
Isolated LV diastolic dysfunction (n=148) |
33 [15-64] | 1.5 [0.7-3.3] | 7.5 [1.4-17.7] | 7.0 [6.3-7.7] |
|
Combined LV dysfunction (n=87) |
42 [22-84] | 1.8 [0.8-4.4] | 12.1 [3.5-29.8] | 6.8 [6.1-7.6] |
|
No LV dysfunction (n=301) |
36 [17-69] | 1.7 [0.7-3.4] | 6.6 [3.0-19.0] | 6.5 [5.8-7.4] |
| p | 0,39 | 0,35 | 0,005 | 0,008 |
Biomarker concentrations shown as median [Q1-Q3]. LV systolic dysfunction was defined as LV ejection fraction ≤ 50% or midwall fractional shortening ≤15%. LV diastolic dysfunction was identified by any condition that differed from normal LV diastolic function, defined as an E/A ratio between 0.75 and 1.5 and E wave deceleration time >140 msec. NT-proBNP = N-terminal probrain natriuretic peptide, hsCRP= high sensitivity C-reactive protein, UACR = urinary albumin to creatinine ratio, HbA1c = glycated hemoglobin.
References:
- Cioffi G, Giorda CB, Chinali M, Di Lenarda A, Faggiano P, Lucci D, Maggioni AP, Masson S, Mureddu GF, Tarantini L, Velussi M, Comaschi M; DYDA Investigators. Analysis of midwall shortening reveals high prevalence of left ventricular myocardial dysfunction in patients with diabetes mellitus: the DYDA study. Eur J Prev Cardiol. 2012;19:935-43.
- Giorda CB, Cioffi G, de Simone G, Di Lenarda A, Faggiano P, Latini R, Lucci D, Maggioni AP, Tarantini L, Velussi M, Verdecchia P, Comaschi M; DYDA Investigators. Predictors of early-stage left ventricular dysfunction in type 2 diabetes: results of DYDA study. Eur J Cardiovasc Prev Rehabil. 2011;18:415-23.
- Cioffi G, Faggiano P, Lucci D, Maggioni AP, Manicardi V, Travaglini A, Girfoglio D, Masson S, Giorda CB, Velussi M, Di Lenarda A, Verdecchia P, Comaschi M. Left ventricular dysfunction and outcome at two-year follow-up in patients with type 2 diabetes: The DYDA study. Diabetes Res Clin Pract. 2013;101:236-42.
- Masson S, Latini R, Cioffi G, Urso R, Vago T, Lucci D, Mureddu GF, TarantiniL, Faggiano P, Girfoglio D, Velussi M, Maggioni AP, Giorda CB, Comaschi M; DYDAInvestigators. Cardiovascular biomarkers, cardiac dysfunction, and outcomes in patients with type 2 diabetes: a prospective, multicenter study. Diabetes Care.2013;36:e137-8.
