Table 5 Results of cluster analysis of patients with diabetic cardiomyopathy. 4 discrete phenogroups were identified. The 4 groups had different dominant variables; these included younger age with higher blood pressures (Cluster 1), lower BMI and lower blood pressures (Cluster 2), less diastolic dysfunction and less cardiac remodeling (Cluster 3) and oldest age with worse diastolic dysfunction, cardiac remodeling and higher biomarkers Cluster 4)
From: Characterizing diabetic cardiomyopathy: baseline results from the ARISE-HF trial
Cluster 1 “Younger Hypertensive” | Cluster 2 “Lower BMI and lower blood pressures” | Cluster 3 “Less LA and LV remodeling” | Cluster 4 “Older with high-risk features” | p | |
|---|---|---|---|---|---|
n | 229 | 140 | 228 | 94 | |
AGE, mean (SD) | 66.2 (7.1) | 67.1 (7.7) | 68.2 (7.0) | 68.5 (6.7) | 0.02 |
FEMALE (%) | 110 (48.0) | 77 (55.0) | 114 (50.0) | 47 (50.0) | 0.63 |
RACE (%) | 0.03 | ||||
White | 142 (62.0) | 83 (59.3) | 153 (67.1) | 54 (57.4) | |
Hispanic | 50 (21.8) | 26 (18.6) | 47 (20.6) | 28 (29.8) | |
Asian | 24 (10.5) | 14 (10.0) | 16 (7.0) | 2 (2.1) | |
Black | 10 (4.4) | 13 (9.3) | 11 (4.8) | 8 (8.5) | |
American Indian or Alaskan Native | 1 (0.4) | 3 (2.1) | 0 (0.0) | 0 (0.0) | |
Other | 2 (0.9) | 1 (0.7) | 1 (0.4) | 2 (2.1) | |
Body-mass index, kg/m2, mean ± SD | 31.1 (4.5) | 29.5 (4.4) | 30.6 (4.7) | 31.1 (4.5) | 0.01 |
Smoker (%) | 0.73 | ||||
Current | 23 (10.0) | 10 (7.1) | 22 (9.6) | 9 (9.6) | |
Never | 123 (53.7) | 86 (61.4) | 130 (57.0) | 48 (51.1) | |
Previous | 83 (36.2) | 44 (31.4) | 76 (33.3) | 37 (39.4) | |
Vital signs at screening | |||||
Systolic blood pressure, mmHg, mean ± SD | 133 (9) | 116 (8) | 134 (8) | 127 (10) | < 0.001 |
Diastolic blood pressure, mmHg, mean ± SD | 79 (7) | 69 (8) | 78 (7) | 74 (8) | < 0.001 |
Heart rate, beats/minute, mean ± SD | 72 (12) | 67 (10) | 67 (10) | 69 (10) | < 0.001 |
Medical history, N, % | |||||
Hypertension | 185 (80.8) | 99 (70.7) | 167 (73.2) | 72 (76.6) | 0.12 |
Dyslipidemia | 40 (17.5) | 23 (16.4) | 37 (16.2) | 17 (18.1) | 0.97 |
Duration of T2DM, years, mean ± SD | 14.4 (10.1) | 14.8 (12.2) | 13.8 (8.7) | 15.4 (9.7) | 0.96 |
Concomitant medications, N, % | |||||
Statins | 180 (78.6) | 119 (85.0) | 180 (78.9) | 79 (84.0) | 0.33 |
ACEi or ARB | 181 (79.0) | 103 (73.6) | 164 (71.9) | 71 (75.5) | 0.35 |
Beta blocker | 47 (20.5) | 26 (18.6) | 64 (28.1) | 24 (25.5) | 0.12 |
MRA | 9 (3.9) | 4 (2.9) | 6 (2.6) | 2 (2.1) | 0.80 |
Hydrochlorothiazide | 49 (21.4) | 25 (17.9) | 37 (16.2) | 22 (23.4) | 0.36 |
SGLT2 inhibitor | 77 (33.6) | 54 (38.6) | 67 (29.4) | 23 (24.5) | 0.10 |
GLP-1 receptor agonist | 58 (25.3) | 48 (34.3) | 49 (21.5) | 18 (19.1) | 0.02 |
Metformin | 169 (73.8) | 105 (75.0) | 170 (74.6) | 68 (72.3) | 0.97 |
Insulin | 70 (30.6) | 41 (29.3) | 51 (22.4) | 26 (27.7) | 0.23 |
Sulfonylurea | 55 (24.0) | 34 (24.3) | 51 (22.4) | 20 (21.3) | 0.93 |
DPP4 inhibitor | 26 (11.4) | 22 (15.7) | 25 (11.0) | 12 (12.8) | 0.55 |
Laboratory tests | |||||
NT-proBNP, ng/L, median (Q1, Q3) | 65 (32, 122) | 63 (31, 109) | 84 (47, 143) | 82 (37, 149) | 0.01 |
Hs-cTnT, ng/L, median (Q1, Q3) | 9 (6, 12) | 8 (5, 10) | 9 (6, 12) | 10 (7, 14) | 0.02 |
HbA1c, mean ± SD | 6.98 (0.79) | 7.01 (0.73) | 6.94 (0.84) | 7.01 (0.74) | 0.83 |
Hemoglobin, g/L, mean ± SD | 13.8 (1.44) | 13.5 (1.30) | 13.7 (1.40) | 13.5 (1.39) | 0.09 |
CKD-Epi, eGFR, mL/min/1.73m2, mean ± SD | 82.7 (16.1) | 81.5 (15.2) | 78.6 (16.7) | 78.1 (16.5) | 0.02 |
Albumin/Creatinine, median (Q1, Q3) | 16 (9, 52) | 10 (6, 23) | 16 (9, 44) | 14 (7, 38) | < 0.001 |
Total cholesterol, mg/dL, median (Q1, Q3) | 152 (127, 178) | 152 (132, 181) | 157 (138, 186) | 156 (134, 182) | 0.24 |
HDL cholesterol, mg/dL, median (Q1, Q3) | 45 (39, 57) | 49 (39, 61) | 49 (39, 60) | 47 (38, 57) | 0.17 |
LDL cholesterol, mg/dL, median (Q1, Q3) | 71 (53, 98) | 69 (57, 94) | 74 (57, 97) | 73 (55, 90) | 0.75 |
Triglycerides, mg/dL, median (Q1, Q3) | 116 (90, 196) | 127 (105, 216) | 127 (113, 149) | 138 (122, 147) | 0.93 |
Echocardiographic measurements | |||||
E/e’, median (Q1, Q3) | 11.3 (10.4, 13.2) | 8.9 (8.0, 10.2) | 7.6 (6.7, 8.6) | 15.4 (10.0, 16.4) | < 0.001 |
GLS, %, median (Q1, Q3) | -17.7 (-19.4, -15.1) | -17.3 (-19.7, -15.2) | -18.0 (-19.3, -15.3) | -17.9 (-19.5, -15.6) | 0.83 |
LAVI, mL/m2, median (Q1, Q3) | 28.8 (26.0, 33.1) | 22.3 (19.9, 25.4) | 18.6 (16.4, 21.3) | 30.2 (23.1, 38.9) | < 0.001 |
LVEF, %, median (Q1, Q3) | 62 (59, 66] | 62 (59, 66) | 62 (59, 66) | 63 (59, 66) | 0.99 |
LVMI, g/m2, median (Q1, Q3) | 83 (78, 90) | 69 (64, 75) | 61 (54, 67) | 115 (106, 121) | < 0.001 |
RVSP, mmHg, median (Q1, Q3) | 23 (18, 27) | 23 (18, 27) | 24 (20, 28) | 23 (19, 28) | 0.45 |
Abnormal echocardiogram, N, % | |||||
GLS > -16% | 60 (26.2) | 43 (30.7) | 56 (24.6) | 16 (17.0) | 0.13 |
E/e’ ≥ 13 | 66 (28.8) | 5 (3.6) | 1 (0.4) | 50 (53.2) | < 0.001 |
LAVi > 34 mL/m2 | 47 (20.5) | 3 (2.1) | 2 (0.9) | 30 (31.9) | < 0.001 |
LVMI ≥ 115 g/m2 in men and ≥ 95 g/m2 in women | 10 (4.4) | 0 (0.0) | 0 (0.0) | 72 (76.6) | < 0.001 |
RVSP > 35 mmHg | 5 (2.2) | 9 (6.4) | 9 (3.9) | 4 (4.3) | 0.24 |
Questionnaires | |||||
KCCQ physical limitation score, mean ± SD | 89 (17) | 90 (16) | 89 (16) | 88 (17) | 0.89 |
KCCQ symptom stability score, mean ± SD | 52 (10) | 51 (8) | 52 (11) | 52 (11) | 0.39 |
KCCQ symptom burden score, mean ± SD | 93 (14) | 92 (15) | 92 (14) | 92 (14) | 0.96 |
KCCQ self-efficacy score, mean ± SD | 87 (22) | 84 (24) | 84 (24) | 83 (23) | 0.41 |
KCCQ quality of life score, mean ± SD | 87 (20) | 87 (20) | 88 (19) | 86 (19) | 0.95 |
KCCQ social limitation score, mean ± SD | 93 (17) | 93 (18) | 92 (18) | 92 (15) | 0.94 |
KCCQ total symptom score, mean ± SD | 93 (14) | 92 (15) | 92 (14) | 91 (15) | 0.88 |
KCCQ clinical summary score, mean ± SD | 91 (14) | 91 (14) | 91 (14) | 89 (15) | 0.78 |
KCCQ overall summary score, mean ± SD | 90 (15) | 90 (15) | 90 (15) | 89 (14) | 0.92 |
PASE score, mean ± SD | 158 (94) | 159 (88) | 156 (89) | 139 (85) | 0.37 |
CPET | |||||
Duration of CPET test, min, mean ± SD | 9.91 (2.50) | 9.73 (2.15) | 9.78 (2.35) | 9.34 (2.63) | 0.30 |
Peak VO2, mL/kg/min, mean ± SD | 15.9 (4.1) | 15.6 (3.5) | 15.9 (3.7) | 15.0 (3.9) | 0.24 |
VE/VCO2 slope, mean ± SD | 30.9 (5.1) | 31.2 (5.0) | 31.5 (6.0) | 31.4 (5.2) | 0.74 |
Peak respiratory exchange rate, mean ± SD | 1.17 (0.09) | 1.21 (0.10) | 1.17 (0.10) | 1.18 (0.10) | 0.002 |