Inappropriate left ventricular mass independently predicts cardiovascular mortality in patients with type 2 diabetes.

OBJECTIVE – Inappropriately high left ventricular mass (iLVM) is associated with adverse cardiovascular (CV) outcomes in nondiabetic patients with asymptomatic aortic stenosis or hypertension. Whether iLVM has prognostic value also in people with type 2 diabetes is still unknown. We, therefore, examined whether iLVM predicts CV mortality in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS – We analyzed echocardiographic data from 360 type 2 diabetic outpatients without overt cardiac disease collected during 1990–2007. iLVM was diagnosed by Doppler echocardiography as measured LVM >128% of the expected LVM predicted from sex, height and stroke work.RESULTS – At baseline, 129 (36%) patients had iLVM. During a 11-year follow-up, 54 (15%) patients died, 31 of whom from CV causes. CV death occurred in 19 (15%) and 12 (5%) of patients with and without iLVM, respectively (P=0.002). Cox regression analysis revealed that iLVM was associated with increased CV mortality (adjusted-hazard ratio 1.23 per each 10% increase in observed/predicted LVM [95% CI 1.02-1.44], P=0.028), independently of potential confounding variables. Conventionally measured LVM was also associated with increased CV mortality but its significance was lost when tested together with iLVM. Receiving operating characteristic curves confirmed a better prediction for CV mortality using iLVM in place of conventionally measured LVM (P=0.015 by the z statistic).CONCLUSIONS – iLVM is highly prevalent in type 2 diabetic patients without overt cardiac disease and provides a more accurate risk prediction of CV mortality than conventionally measured LVM.