Abstract 12349: Can Biomarkers and Risk Scores Be Used to Select Patients With Type 2 Diabetes Mellitus for Testing for Subclinical Left Ventricular Dysfunction

Background: Subclinical LV dysfunction (LVD) identifies heart failure (HF) risk in type 2 diabetes mellitus (T2DM). Hypothesis: Clinical scores (ARIC HF and WATCH-DM) and NTpBNP can be used as screening tests to identify which people should undergo echo. Methods: 803 asymptomatic subjects (69 years [IQR 65-73], 36% female) with T2DM were prospectively recruited from three community-based populations. All underwent a comprehensive echo to identify abnormal global longitudinal strain (GLS > -16%), diastolic function (E/e’ > 14 or e’<8cm/s), left atrial volume index (LAV>34ml/m 2 ) or LV hypertrophy (LV mass index>88g/m 2 (F)>102g/m 2 (M)). ARIC HF risk at 4 years and WATCH-DM scores were calculated from clinical data. NTpBNP was measured using an electro-chemiluminescence assay. Results: In the cohort, 126 (17%) had an abnormal GLS, 16 (2%) elevated E/e’, 266 (33%) had impaired e’, 351 (44%) had increased LAV and 113 (14%) had LV hypertrophy. Median NTpBNP level was 50pg/mL [25-101]. Clinical scores corresponded to expected HF risk (ARIC-HF 8% [4-12]; WATCH-DM 10 points [8-12]). NTpBNP was weakly associated with GLS after adjustments for age, body-mass index, and renal function (β=0.004 [95% CI 0.003 to 0.004], p<0.001). Similar trends were observed with ARIC HF (β=0.07 [0.05 to 0.09], p<0.001) and WATCH-DM (β=0.19 [0.13 to 0.25], p<0.001) in univariable analyses. None of the risk assessment tools provided a satisfactory AUC for detection of abnormal GLS, diastolic indices or LV mass (Table) ( p =0.804). Development of cut-points to optimize sensitivity (to 90%) led to an unacceptably low specificity (Table). Conclusion: Although risk assessment based on clinical scores or biomarkers would be desirable to stratify HF risk in people with T2DM, they show a weak relationship with subclinical LV dysfunction.