Impact of diabetes on remodelling, microvascular function and exercise capacity in aortic stenosis
Year: 2023
Type: article
Study design: Observational Study
Abstract: Objective To characterise cardiac remodelling, exercise capacity and fibroinflammatory biomarkers in patients with aortic stenosis (AS) with and without diabetes, and assess the impact of diabetes on outcomes. Methods Patients with moderate or severe AS with and without diabetes underwent echocardiography, stress cardiovascular magnetic resonance (CMR), cardiopulmonary exercise testing and plasma biomarker analysis. Primary endpoint for survival analysis was a composite of cardiovascular mortality, myocardial infarction, hospitalisation with heart failure, syncope or arrhythmia. Secondary endpoint was all-cause death. Results Diabetes (n=56) and non-diabetes groups (n=198) were well matched for age, sex, ethnicity, blood pressure and severity of AS. The diabetes group had higher body mass index, lower estimated glomerular filtration rate and higher rates of hypertension, hyperlipidaemia and symptoms of AS. Biventricular volumes and systolic function were similar, but the diabetes group had higher extracellular volume fraction (25.9%±3.1% vs 24.8%±2.4%, p=0.020), lower myocardial perfusion reserve (2.02±0.75 vs 2.34±0.68, p=0.046) and lower percentage predicted peak oxygen consumption (68%±21% vs 77%±17%, p=0.002) compared with the non-diabetes group. Higher levels of renin (log 10 renin: 3.27±0.59 vs 2.82±0.69 pg/mL, p<0.001) were found in diabetes. Multivariable Cox regression analysis showed diabetes was not associated with cardiovascular outcomes, but was independently associated with all-cause mortality (HR 2.04, 95% CI 1.05 to 4.00; p=0.037). Conclusions In patients with moderate-to-severe AS, diabetes is associated with reduced exercise capacity, increased diffuse myocardial fibrosis and microvascular dysfunction, but not cardiovascular events despite a small increase in mortality.
Source: Open Heart
Authors: Abhishek Dattani, Emer M Brady, Aseel Alfuhied, Gaurav S Gulsin, Christopher D Steadman, Jian L Yeo, Saadia Aslam, Marko Banovic, Michael Jerosch-Herold, Hui Xue, Peter Kellman, Philippe Costet, Mary Ellen Cvijic, Lei Zhao, Christina Ebert, Laura Liu, Kushan Gunawardhana, David Gordon, Ching-Pin Chang, J Ranjit Arnold, Thomas Yates, Damian Kelly, Kai Hogrefe, Dana Dawson, John Greenwood, Leong L Ng, Anvesha Singh, Gerry P McCann
Institutions: University of Leicester, NIHR Leicester Biomedical Research Centre, Poole Hospital, Poole Hospital NHS Foundation Trust, Univerzitetski Klinički Centar Srbije, Brigham and Women's Hospital, National Institutes of Health, National Heart, Lung, and Blood Institute, Bristol-Myers Squibb (United States), Royal Derby Hospital, Kettering General Hospital, Kettering General Hospital NHS Trust, University of Aberdeen, University of Leeds, Leeds Teaching Hospitals NHS Trust
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,391
Awards: What is the best test for the non-invasive diagnosis of significant coronary artery disease?, Heart failure in type 2 diabetes: improving diagnosis and management in a multi-ethnic population., G3891960553, A novel cardiac magnetic resonance technique to quantify altered myocardial calcium handling in diabetic cardiomyopathy and the response to lifestyle intervention, Prognostic Importance of Microvascular Dysfunction in Asymptomatic Patients with Aortic Stenosis., G6112330444, G6929902608, G7017231308, G778364364, Assessing the impact of early aortic valve replacement on irreversible heart damage and patient reported outcomes in asymptomatic Aortic Stenosis.
OpenAlex ID: W4385863875