Comparing the influence of 2009 versus 2016 ASE/EACVI diastolic function guidelines on the prevalence and echocardiographic characteristics of preclinical diastolic dysfunction (stage B heart failure) in a Hispanic population with type 2 diabetes mellitus

Aims: To identify prevalence and predictors of undetected pre-clinical diastolic dysfunction (PDD) in a cohort of adult Hispanic patients with type 2 diabetes (T2D), and compare variations in epidemiology and echocardiographic characteristics between categorization based on the 2009 versus 2016 guidelines. Methods: From 2013 to 2016, a cross-sectional cohort study of adults with T2D was performed. Patients without signs/symptoms of heart failure (HF) underwent 2D/Doppler echocardiographic screening, and were grouped into two subcohorts: 1) normal diastolic function, and 2) PDD, defined by the 2009 or 2016 ASE/EACVI criteria. Results: Among 307 Hispanic subjects, by 2009 criteria, 193 (62.9%) had normal diastolic function, 113 (36.8%) diastolic dysfunction and 1 (0.3%) indeterminate. Those that had diastolic dysfunction (DD) were older (mean age 59.1 ± 12.7 vs 52.2 ± 12.2 years, p < 0.0001), with higher proportion female (69.0 vs 53.9%, p = 0.0092), and higher systolic blood pressure (136.5 ± 18.6 vs 131.7 ± 19.9, p = 0.0372). By 2016 criteria, 261 (85%) had normal diastolic function, 22 (7.2%) diastolic dysfunction and 24 (7.8%) indeterminate. Among those that had normal diastolic function (n = 261) by 2016 criteria, 29% (n = 76) had DD by 2009 criteria, and they were more likely to have higher E/e′ and left atrial volume index (LAVI). Conclusions: By applying the 2016 versus the 2009 diastolic function criteria to a Hispanic population with T2D, the prevalence of PDD decreased significantly from 37% to 7%. These findings are consistent with recent studies demonstrating that the 2016 ASE/EACVI guidelines are more specific for diagnosing DD and hence less sensitive leading to lower prevalence of diastolic dysfunction.