Association of ambulatory blood pressure with coronary microvascular and cardiac dysfunction in asymptomatic type 2 diabetes
Year: 2022
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Type 2 diabetes (T2D) and hypertension commonly coexist and are associated with subclinical myocardial structural and functional changes. We sought to determine the association between blood pressure (BP) and left ventricular (LV) remodeling, systolic/diastolic function, and coronary microvascular function, among individuals with T2D without prevalent cardiovascular disease. METHODS: Participants with T2D and age-, sex-, and ethnicity-matched controls underwent comprehensive cardiovascular phenotyping including fasting bloods, transthoracic echocardiography, cardiovascular magnetic resonance imaging with quantitative adenosine stress/rest perfusion, and office and 24-h ambulatory BP monitoring. Multivariable linear regression was performed to determine independent associations between BP and imaging markers of remodeling and function in T2D. RESULTS: Individuals with T2D (n = 205, mean age 63 ± 7 years) and controls (n = 40, mean age 61 ± 8 years) were recruited. Mean 24-h systolic BP, but not office BP, was significantly greater among those with T2D compared to controls (128.8 ± 11.7 vs 123.0 ± 13.1 mmHg, p = 0.006). Those with T2D had concentric LV remodeling (mass/volume 0.91 ± 0.15 vs 0.82 ± 0.11 g/mL, p < 0.001), decreased myocardial perfusion reserve (2.82 ± 0.83 vs 3.18 ± 0.82, p = 0.020), systolic dysfunction (global longitudinal strain 16.0 ± 2.3 vs 17.2 ± 2.1%, p = 0.004) and diastolic dysfunction (E/e' 9.30 ± 2.43 vs 8.47 ± 1.53, p = 0.044) compared to controls. In multivariable regression models adjusted for 14 clinical variables, mean 24-h systolic BP was independently associated with concentric LV remodeling (β = 0.165, p = 0.031), diastolic dysfunction (β = 0.273, p < 0.001) and myocardial perfusion reserve (β = - 0.218, p = 0.016). Mean 24-h diastolic BP was associated with LV concentric remodeling (β = 0.201, p = 0.016). CONCLUSION: 24-h ambulatory systolic BP, but not office BP, is independently associated with cardiac remodeling, coronary microvascular dysfunction, and diastolic dysfunction among asymptomatic individuals with T2D. (Clinical trial registration. URL: https://clinicaltrials.gov/ct2/show/NCT03132129 Unique identifier: NCT03132129).
Source: Cardiovascular Diabetology
Authors: Jian L. Yeo, Gaurav S. Gulsin, Emer M. Brady, Abhishek Dattani, Joanna M. Bilak, Anna-Marie Marsh, Manjit Sian, Lavanya Athithan, Kelly S. Parke, Joanne Wormleighton, Matthew P. M. Graham-Brown, Anvesha Singh, J. Ranjit Arnold, Claire Lawson, Melanie J. Davies, Hui Xue, Peter Kellman, Gerry P. McCann
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,590
Awards: G2054916187, G223159513, What is the best test for the non-invasive diagnosis of significant coronary artery disease?, Novel interventions to reverse cardiovascular dysfunction assessed by Magnetic Resonance Imaging, Heart failure in type 2 diabetes: improving diagnosis and management in a multi-ethnic population., Predicting hospitalisation in heart failure: incorporating dynamic patient-reported measures in a prognostic model to improve outcomes, A novel cardiac magnetic resonance technique to quantify altered myocardial calcium handling in diabetic cardiomyopathy and the response to lifestyle intervention, G4978604209, University of British Columbia Advanced Cardiac Imaging Fellowship: 1) Understanding bioprosthetic leaflet degeneration in patients with and without type 2 diabetes – a pilot study, and 2) Coronary artery plaque characteristics and their association with outcomes – analyses from the ISCHEMIA trial, Cardiac rest and stress metabolism in patients with type 2 diabetes. ,
OpenAlex ID: W4281701618