Albuminuria as a Clinical Marker of Subclinical Myocardial Dysfunction in Diabetes: A Systematic Review and Meta-analysis.
Eman Elsheikh
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis examined whether albuminuria is associated with echocardiographic evidence of subclinical myocardial dysfunction in adults with diabetes. It included 18 reports representing 17 independent observational cohorts; eight contributed to quantitative synthesis. Compared with normoalbuminuria, albuminuria was associated with lower absolute global longitudinal strain (mean difference, -1.38 percentage points; 95% CI, -2.13 to -0.63; P < 0.001; I² = 82%) and higher E/e', while ejection fraction did not differ. Albuminuria was also independently associated with impaired strain and greater odds of subclinical dysfunction.
Key findings
- Absolute global longitudinal strain was lower with albuminuria (MD, -1.38 percentage points; 95% CI, -2.13 to -0.63; P < 0.001; I² = 82%).
- E/e' was higher in albuminuric patients (MD, 1.21; 95% CI, 0.18-2.24; P = 0.021), while ejection fraction did not differ.
- Albuminuria was independently associated with impaired strain (pooled β = 1.06; 95% CI, 0.44-1.68) and higher odds of subclinical dysfunction (OR = 5.55; 95% CI, 3.43-8.98).
- A greater strain deficit was observed from microalbuminuria to macroalbuminuria, but formal trend analysis was not possible.
Why it matters
The findings link a routinely assessed marker of microvascular injury with subclinical systolic and diastolic myocardial abnormalities in diabetes, even when ejection fraction is preserved. This may help identify patients in whom myocardial dysfunction is not apparent from conventional systolic function measures, while the substantial heterogeneity in strain results warrants cautious interpretation.
What to keep in mind
The evidence came from observational studies, and only eight of the 18 reports contributed to quantitative synthesis. GLS results showed substantial heterogeneity (I² = 82%); formal analysis of the albuminuria-severity trend was not possible.