Diabetic cardiomyopathy represents a critical stage in the progression towards preventable functional decline. Currently, the value of screening for Stage B heart failure (HF) in asymptomatic Type 2 diabetes (T2D) patients remains undefined. Developing a standardized diagnostic model, focusing on the relationship between the left ventricle and arterial tree via ventriculo-arterial coupling (VAC), may help slow or prevent HF progression well before symptom onset.

This study aims to evaluate the diagnostic utility of pressure-volume loops at rest and after an isometric handgrip test (IHGT) in predicting the onset of HF with preserved ejection fraction (HFpEF) in T2D patients as part of primary cardiovascular prevention.

This prospective, observational, single-center study was conducted at the Central Army Hospital University. From March 2022 to March 2024, 325 patients were included and followed for 12 months. At baseline and after 12 months, patients underwent a transthoracic echocardiography session, complemented by a three-minute IHGT. Diastolic function at rest was defined using the 2016 ASE/EACVI guidelines, and HFpEF diagnosis was determined via the ESC HFA-PEFF score. The Chen method was used for VAC calculation.

After 12 months, 43 patients (13.23%) developed HFpEF. In bivariate analysis, hemodynamic parameters predicting HFpEF occurrence included: At rest: arterial elastance (Ea = 1.89 ± 0.2, P = 0.0001), ejection time (Tej = 0.294 ± 0.03 s, P = 0.001), and the pre-ejection time/ejection time ratio (Tpej/Tej = 0.33 ± 0.07, P = 0.02). Post-IHGT: arterial elastance (Ea = 1.92 ± 0.2, P = 0.0001) and VAC (CVA = 1.84 mmHg/ml ± 0.8, P = 0.053). In multivariate analysis, the predictive parameters were: At rest: global longitudinal strain (GLS), left atrial volume (LAV), pre-ejection time/ejection time ratio, and NTproBNP levels. Post-IHGT: VAC and the E/e’ ratio. Ventricular elastance (Es) at rest and under stress did not predict HFpEF progression ( P = 0.21, P = 0.47, respectively).

Arterial elastance at rest and during IHGT was a predictor of HFpEF in bivariate analysis but not in multivariate analysis. VAC during IHGT emerged as a predictor in both analyses. The hemodynamic response to diastolic stress testing allowed us to categorize our diabetic cohort into two groups: those at high risk of HFpEF progression, indicated by increased VAC, and those at lower risk, marked by stabilized or decreased VAC.