Objective:

To develop and internally validate a clinical prediction model for identifying asymptomatic type 2 diabetes (T2DM) patients at risk of incident heart failure (HF) or progression of subclinical cardiac dysfunction.

Approach:

Key Findings:

• LV GLS declined from 17.4% to 16.9% and LASr deteriorated from 38.5% to 34.0% over 24 months.
• Independent predictors of the composite outcome included LASr ≤24% (HR 3.58), NT-proBNP ≥120 pg/mL (HR 2.48), galectin-3 ≥15 ng/mL (HR 1.79), age ≥70 years, diabetes duration ≥12 years, BMI ≥30 kg/m², and UACR ≥60 mg/g.
• SGLT2i/GLP-1 RA use was associated with lower observed risk.
• 40 patients reached the composite outcome during follow-up, with cumulative incidences of 4.2%, 11.7%, and 27.5% for low, intermediate, and high-risk groups, respectively.
• The full model had a C-statistic of 0.835 and good calibration.

Interpretation:

Limitations:

• The study was conducted at a single center, limiting generalizability.
• External validation and clinical utility assessment are needed before routine use.

Conclusion:

This internally validated model may support preliminary risk stratification for suspected early diabetic cardiomyopathy.

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