Methods to predict heart failure in diabetes patients

ABSTRACT

Introduction

Type 2 diabetes mellitus (T2DM) is one of the leading causes of cardiovascular disease and powerful predictor for new-onset heart failure (HF).

Areas covered

We focus on the relevant literature covering evidence of risk stratification based on imaging predictors and circulating biomarkers to optimize approaches to preventing HF in DM patients.

Expert opinion

Multiple diagnostic algorithms based on echocardiographic parameters of cardiac remodeling including global longitudinal strain/strain rate are likely to be promising approach to justify individuals at higher risk of incident HF. Signature of cardiometabolic status may justify HF risk among T2DM individuals with low levels of natriuretic peptides, which preserve their significance in HF with clinical presentation. However, diagnostic and predictive values of conventional guideline-directed biomarker HF strategy may be non-optimal in patients with obesity and T2DM. Alternative biomarkers affecting cardiac fibrosis, inflammation, myopathy, and adipose tissue dysfunction are plausible tools for improving accuracy natriuretic peptides among T2DM patients at higher HF risk. In summary, risk identification and management of the patients with T2DM with established HF require conventional biomarkers monitoring, while the role of alternative biomarker approach among patients with multiple CV and metabolic risk factors appears to be plausible tool for improving clinical outcomes.

KEYWORDS:

• Heart failure
• diabetes mellitus
• cardiac imaging
• circulating biomarkers
• prognosis
• risk stratification

Article highlights

• Multiple scoring diagnostic algorithms better identify individuals at higher risk of incident HF than conventional echocardiography

• Parameters of cardiometabolic health may reclassify HF risk in T2DM patients with low levels of natriuretic peptides

• Guideline-directed biomarker HF strategy shows non-optimal diagnostic accuracy in patients with obesity and T2DM

• Galectin-3 and soluble suppression of tumorigenesis-2 had non-significant associations with HFpEF induced by T2DM

• The point-of-care HF platform in T2DM plausibly configures alternative circulating biomarkers including growth differentiation factor 15, irisin, adropin, fibroblast growth factor21 and apelin.

• Irisin, adropin and growth differentiation factor-15 seem to show most relevant independent predictive information for HF management.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.