Cardiac phenotypes and cardiovascular risk in people with type 2 diabetes mellitus and chronic coronary artery disease: A Chinese retrospective cohort study

Abstract

Background: Patients with type 2 diabetes mellitus (T2DM) and chronic coronary artery disease (CAD) are at very high risk of major adverse cardiovascular events (MACE), but further risk stratification remains challenging.

Aims: This study aimed to use cluster analysis to identify cardiac phenotypes associated with cardiovascular risk in T2DM and chronic CAD populations.

Methods: Cluster analysis was performed on 12 echocardiographic variables, including aortic and pulmonary artery diameters, atrial and ventricular dimensions, interventricular septum and posterior wall thicknesses, ejection fraction, and blood flow velocities in 1633 Chinese individuals. Survival outcomes were analyzed using Kaplan–Meier methods, Cox proportional hazards models, and restricted cubic splines.

Results: Two distinct phenotypes were identified. Patients in cluster 2 were characterized by larger atrial and ventricular volumes, thicker interventricular septum and posterior walls, higher ventricular mass index, and faster aortic blood flow velocity, summarized as “larger, thicker, faster”. Over a median 15-month follow-up, patients in cluster 2 exhibited higher MACE risk (HR, 1.35; 95% CI, 1.17–1.57), particularly for heart failure hospitalization (HR, 1.37; 95% CI, 1.15–1.64). Consistent results were observed in sex and hypertension subgroups. Fibrinogen ≥3.8 g/l, uric acid ≥329.2 mmol/l, high-density lipoprotein cholesterol ≤1.07 mmol/l, low-density lipoprotein cholesterol ≥2.5 mmol/l, and hemoglobin ≤132 g/l were demonstrated statistically risk factors for MACE in cluster 2.

Conclusions: Cluster analysis of echocardiographic variables may improve the identification of higher risk patients and highlighted the prognostic value of cardiac remodeling in T2DM and chronic CAD populations.