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Review
. 2018 Dec 27;13(12):e0209794.
doi: 10.1371/journal.pone.0209794. eCollection 2018.

The E/e' ratio difference between subjects with type 2 diabetes and controls. A meta-analysis of clinical studies

Giacomo Zoppini  1 , Corinna Bergamini  2 , Alessandro Mantovani  1 , Marco Dauriz  1 , Giovanni Targher  1 , Andrea Rossi  2 , Enzo Bonora  1
Affiliations
Review

The E/e' ratio difference between subjects with type 2 diabetes and controls. A meta-analysis of clinical studies

Giacomo Zoppini et al. PLoS One. .

Abstract

Type 2 diabetes is associated with an increased risk of heart failure. Left ventricular diastolic dysfunction and type 2 diabetes are frequently associated. Using echocardiography, we know that tissue Doppler imaging E/e' ratio is a reliable predictor of left ventricular filling pressure. We performed a systematic review and meta-analysis to investigate the averaged E/e' ratio value in patients with type 2 diabetes compared to non-diabetic controls. In the analysis we included cross-sectional studies providing the averaged E/e' ratio. Subgroup/sensitivity analyses were conducted according to variables known to influence E/e' ratio measurements. The analysis included 15 cross sectional studies with 877 type 2 diabetes patients and 1193 controls. The weighted mean difference showed higher values in diabetes (WMD 2.02; 95% CI 1.35, 2.70; p<0.001). The result was consistent in the subgroup/sensitivity analyses. Visual inspection of the funnel plot did not identify substantial asymmetry and the Egger test for funnel plot asymmetry showed a p value of 0.36. In conclusion, our assessment suggests that averaged E/e' ratio is consistently increased in patients with type 2 diabetes compared to non-diabetic controls in the absence of cardiovascular diseases and complicated hypertension. This alteration may be a precocious diastolic alteration in the diabetic cardiomyopathy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The PRISMA flowchart of the systematic search and quantitative synthesis.
Fig 2
Fig 2. The Forest plot of the weighted mean difference (WMD) of E/e’ ratio with 95% C.I. of the included studies that compared averaged E/e’ between patients with and without diabetes.
A positive value signifies that E/e’ is higher in patients with diabetes.
Fig 3
Fig 3. The Forest plot of the WMD with 95% C.I. of the subgroup analyses: Panel A, region; panel B, matching; panel C, hypertension; panel D, glycemic control.
A positive value signifies that E/e’ is higher in patients with diabetes.
Fig 4
Fig 4. The Funnel plot analysis of the studies included in the analysis.
See this image and copyright information in PMC

References

    1. Seferović PM, Petrie MC, Filippatos GS, Anker SD, Rosano G, Bauersachs J, et al. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2018. March 8 10.1002/ejhf.1170 [Epub ahead of print] Review. - DOI - PubMed
    1. Koye DN, Magliano DJ, Nelson RG, Pavkov ME. The Global Epidemiology of Diabetes and Kidney Disease. Adv Chronic Kidney Dis 2018; 25: 121–132. 10.1053/j.ackd.2017.10.011 - DOI - PMC - PubMed
    1. Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol 2017; 14: 591–602. 10.1038/nrcardio.2017.65 - DOI - PubMed
    1. Mosley JD, Levinson RT, Brittain EL, Gupta DK, Farber-Eger E, Shaffer CM, et al. Clinical Features Associated With Nascent Left Ventricular Diastolic Dysfunction in a Population Aged 40 to 55 Years. Am J Cardiol 2018; S0002-9149: 30278–9. - PMC - PubMed
    1. Nayor M, Enserro DM, Xanthakis V, Larson MG, Benjamin EJ, Aragam J, et al. Comorbidities and Cardiometabolic Disease: Relationship With Longitudinal Changes in Diastolic Function. JACC Heart Fail 2018; 6: 317–325. 10.1016/j.jchf.2017.12.018 - DOI - PMC - PubMed

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