LAUSR

Patients with type 2 diabetes (T2DM) have a significantly increased risk of heart disease and adverse cardiac events(ACE). Many of asymptomatic patients with T2DM have myocardial perfusion defects or coronary artery disease and are not recognized by traditional risk factors. The third harmonic of radial pulse has been proved a risk factor for myocardial ischemia. We sought to further investigate if the third harmonic phase of the radial pulse(P3) could be an independent predictor of ACE and cardiac dysfunction in asymptomatic T2DM patients. The study consisted of 1968 asymptomatic T2DM patients who had no history of angina and cardiovascular disease. We conducted the pulse wave measurement at baseline and dived the enrolled patients into quartile groups based on P3 value(>3.2, 3.0 to 3.2, 2.7 to 3.0, and <2.7). Participated patients received an average of 1.8 years of follow-up. To assess the risk of ACE , the primary outcomes were the composite of myocardial infarction, heart failure, and cardiovascular death. To measure the risk of cardiac dysfunction, the secondary outcomes were composed of newly discovered single or multi coronary stenosis, myocardial ischemia, and left ventricular dysfunciton. Cox proportional hazards model were used. Reference to patients with P3>3.2, the hazard ratios(HR) of patients with P3<2.7 were as follows: (1) myocardial infarction(HR, 1.98; 95% CI, 1.32-2.98), heart failure(HR, 1.64; 95% CI, 0.88-3.06), and cardiovascular death(HR, 3.51; 95% CI, 0.73-16.9); (2) Single coronary stenosis(HR, 10.1; 95% CI, 1.29-78.7), multi coronary stenosis(HR, 9.06; 95% CI, 1.15-71.5), myocardial ischemia(HR, 3.05; 95% CI, 1.37-6.80), and low left ventricular ejection fraction(HR, 2.09; 95% CI, 1.13-38.7). The trend analysis further demonstrated that the reducing P3 leads to higher incidence of both primary and secondary composite outcomes(P<0.001). After adjusting for age, gender, smoking, systolic blood pressure, dyslipidemia, duration of diabetes, and Hba1c, P3 was still an independent predictor of ACE and cardiac dysfunction (P trend <0.005). Conclusively, this report suggested that P3 provides independent predictive value for risk assessment of ACE and cardiac dysfunction in asymptomatic patients with T2DM.