{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T15:41:48Z","timestamp":1788363708638,"version":"build-2803163510"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2020,5,9]],"date-time":"2020-05-09T00:00:00Z","timestamp":1588982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100014499","name":"Stanford Diabetes Research Center","doi-asserted-by":"publisher","award":["P30DK116074"],"award-info":[{"award-number":["P30DK116074"]}],"id":[{"id":"10.13039\/100014499","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R18DK09639405"],"award-info":[{"award-number":["R18DK09639405"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01DK08137110"],"award-info":[{"award-number":["R01DK08137110"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Philips Royal Precision Medicine Initiative"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Resting echocardiography is a valuable method for detecting subclinical heart failure (HF) in patients with diabetes mellitus (DM). However, few studies have assessed the incremental value of diastolic stress for detecting subclinical HF in this population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Asymptomatic patients with Type 2 DM were prospectively enrolled. Subclinical HF was assessed using systolic dysfunction (left ventricular longitudinal strain &amp;lt;16% at rest and &amp;lt;19% after exercise in absolute value), abnormal cardiac morphology, or diastolic dysfunction (E\/e\u2032 &amp;gt; 10). Metabolic equivalents (METs) were calculated using treadmill speed and grade, and functional capacity was assessed by percent-predicted METs (ppMETs). Among 161 patients studied (mean age of 59\u2009\u00b1\u200911\u2009years and 57% male sex), subclinical HF was observed in 68% at rest and in 79% with exercise. Among characteristics, diastolic stress had the highest yield in improving detection of HF with 57% of abnormal cases after exercise and 45% at rest. Patients with revealed diastolic dysfunction during stress had significantly lower exercise capacity than patients with normal diastolic stress (7.3\u2009\u00b1\u20092.1 vs. 8.8\u2009\u00b1\u20092.5, P\u2009&amp;lt;\u20090.001 for peak METs and 91\u2009\u00b1\u200930% vs. 105\u2009\u00b1\u200930%, P\u2009=\u20090.04 for ppMETs). On multivariable modelling found that age (beta = \u22120.33), male sex (beta\u2009=\u20090.21), body mass index (beta = \u22120.49), and exercise E\/e\u2032 &amp;gt;10 (beta = \u22120.17) were independently associated with peak METs (combined R2 = 0.46). A network correlation map revealed the connectivity of peak METs and diastolic properties as central features in patients with DM.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Diastolic stress test improves the detection of subclinical HF in patients with diabetes mellitus.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaa070","type":"journal-article","created":{"date-parts":[[2020,3,25]],"date-time":"2020-03-25T20:09:54Z","timestamp":1585166994000},"page":"876-884","source":"Crossref","is-referenced-by-count":18,"title":["Incremental value of diastolic stress test in identifying subclinical heart failure in patients with diabetes mellitus"],"prefix":"10.1093","volume":"21","author":[{"given":"Tomoko","family":"Nishi","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA"},{"name":"Stanford Cardiovascular Institute, 300 Pasteur Dr H2170, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8304-8194","authenticated-orcid":false,"given":"Yukari","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA"},{"name":"Stanford Cardiovascular Institute, 300 Pasteur Dr H2170, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey W","family":"Christle","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA"},{"name":"Stanford Sports Cardiology, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Cauwenberghs","sequence":"additional","affiliation":[{"name":"Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Kapucijnenvoer 35 blok d - box 7001 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalyani","family":"Boralkar","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA"},{"name":"Stanford Cardiovascular Institute, 300 Pasteur Dr H2170, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kegan","family":"Moneghetti","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA"},{"name":"Stanford Cardiovascular Institute, 300 Pasteur Dr H2170, Stanford, CA 94305, USA"},{"name":"Stanford Sports Cardiology, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myriam","family":"Amsallem","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA"},{"name":"Stanford Cardiovascular Institute, 300 Pasteur Dr H2170, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristofer","family":"Hedman","sequence":"additional","affiliation":[{"name":"Stanford Cardiovascular Institute, 300 Pasteur Dr H2170, Stanford, CA 94305, USA"},{"name":"Department of Clinical Physiology, Link\u00f6ping University, SE-581 83 Link\u00f6ping, Sweden"},{"name":"Department of Medical and Health Sciences, Link\u00f6ping University, SE-581 83 Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K\u00e9vin","family":"Contrepois","sequence":"additional","affiliation":[{"name":"Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Myers","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Veterans Affairs Palo Alto Healthcare System and Stanford University, 3801 Miranda Avenue, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth W","family":"Mahaffey","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford Center for Clinical Research, 300 Pasteur Dr, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingela","family":"Schnittger","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA"},{"name":"Stanford Cardiovascular Institute, 300 Pasteur Dr H2170, Stanford, CA 94305, 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