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Title: Global longitudinal strain and plasma biomarkers for prognosis in heart failure complicated by diabetes: a prospective observational study
Authors: Iyer, Nithin R.
Chan, Siew-Pang
Liew, Oi Wah
Chong, Jenny P. C.
Bryant, Jennifer A.
Le, Thu-Thao
Chandramouli, Chanchal
Cozzone, Patrick J.
Eisenhaber, Frank
Foo, Roger
Richards, A. Mark
Lam, Carolyn S. P.
Ugander, Martin
Chin, Calvin W-L.
Keywords: Medicine, Health and Life Sciences
Issue Date: 2024
Source: Iyer, N. R., Chan, S., Liew, O. W., Chong, J. P. C., Bryant, J. A., Le, T., Chandramouli, C., Cozzone, P. J., Eisenhaber, F., Foo, R., Richards, A. M., Lam, C. S. P., Ugander, M. & Chin, C. W. (2024). Global longitudinal strain and plasma biomarkers for prognosis in heart failure complicated by diabetes: a prospective observational study. BMC Cardiovascular Disorders, 24(1), 141-.
Project: SPF2014/003 
Journal: BMC Cardiovascular Disorders 
Abstract: Background: Heart failure (HF) and diabetes are associated with increased incidence and worse prognosis of each other. The prognostic value of global longitudinal strain (GLS) measured by cardiovascular magnetic resonance (CMR) has not been established in HF patients with diabetes. Methods: In this prospective, observational study, consecutive patients (n = 315) with HF underwent CMR at 3T, including GLS, late gadolinium enhancement (LGE), native T1, and extracellular volume fraction (ECV) mapping. Plasma biomarker concentrations were measured including: N-terminal pro B-type natriuretic peptide(NT-proBNP), high-sensitivity troponin T(hs-TnT), growth differentiation factor 15(GDF-15), soluble ST2(sST2), and galectin 3(Gal-3). The primary outcome was a composite of all-cause mortality or HF hospitalisation. Results: Compared to those without diabetes (n = 156), the diabetes group (n = 159) had a higher LGE prevalence (76 vs. 60%, p < 0.05), higher T1 (1285±42 vs. 1269±42ms, p < 0.001), and higher ECV (30.5±3.5 vs. 28.8±4.1%, p < 0.001). The diabetes group had higher NT-pro-BNP, hs-TnT, GDF-15, sST2, and Gal-3. Diabetes conferred worse prognosis (hazard ratio (HR) 2.33 [95% confidence interval (CI) 1.43–3.79], p < 0.001). In multivariable Cox regression analysis including clinical markers and plasma biomarkers, sST2 alone remained independently associated with the primary outcome (HR per 1 ng/mL 1.04 [95% CI 1.02–1.07], p = 0.001). In multivariable Cox regression models in the diabetes group, both GLS and sST2 remained prognostic (GLS: HR 1.12 [95% CI 1.03–1.21], p = 0.01; sST2: HR per 1 ng/mL 1.03 [95% CI 1.00-1.06], p = 0.02). Conclusions: Compared to HF patients without diabetes, those with diabetes have worse plasma and CMR markers of fibrosis and a more adverse prognosis. GLS by CMR is a powerful and independent prognostic marker in HF patients with diabetes.
ISSN: 1471-2261
DOI: 10.1186/s12872-024-03810-5
Schools: School of Biological Sciences 
Organisations: Bioinformatics Institute, A*STAR 
Rights: © The Author(s) 2024. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Fulltext Permission: open
Fulltext Availability: With Fulltext
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