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White L, Kirwan M, Christie V, Hurst L, Gwynne K. The Effectiveness of Clinician-Led Community-Based Group Exercise Interventions on Health Outcomes in Adults with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:601. [PMID: 38791815 PMCID: PMC11120654 DOI: 10.3390/ijerph21050601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024]
Abstract
This systematic review and meta-analysis evaluated the combined effects of clinician-led and community-based group exercise interventions on a range of health outcomes in adults with type 2 diabetes mellitus. Our literature search spanned Medline, Scopus, PubMed, Embase, and CINAHL databases, focusing on peer-reviewed studies published between January 2003 and January 2023. We included studies involving participants aged 18 years and older and articles published in English, resulting in a dataset of eight studies with 938 participants. Spanning eight peer-reviewed studies with 938 participants, the analysis focused on the interventions' impact on glycemic control, physical fitness, and anthropometric and hematological measurements. Outcomes related to physical fitness, assessed through the six-minute walk test, the 30 s sit-to-stand test, and the chair sit-and-reach test, were extracted from five studies, all of which reported improvements. Anthropometric outcomes from seven studies highlighted positive changes in waist circumference and diastolic blood pressure; however, measures such as body mass index, systolic blood pressure, weight, and resting heart rate did not exhibit significant changes. Hematological outcomes, reviewed in four studies, showed significant improvements in fasting blood glucose, triglycerides, and total cholesterol, with glycemic control evidenced by reductions in HbA1c levels, yet LDL and HDL cholesterol levels remained unaffected. Ten of the fifteen outcome measures assessed showed significant enhancement, indicating that the intervention strategies implemented may offer substantial health benefits for managing key type 2 diabetes mellitus-related health parameters. These findings in combination with further research, could inform the refinement of physical activity guidelines for individuals with type 2 diabetes mellitus, advocating for supervised group exercise in community settings.
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Affiliation(s)
- Liam White
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Talavera Road, North Ryde, NSW 2109, Australia; (L.W.); (M.K.); (L.H.)
| | - Morwenna Kirwan
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Talavera Road, North Ryde, NSW 2109, Australia; (L.W.); (M.K.); (L.H.)
| | - Vita Christie
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research, Heart Research Institute, Eliza Street, Newtown, NSW 2042, Australia;
- DVC Indigenous Office, University of New South Wales, High Street, Sydney, NSW 2052, Australia
| | - Lauren Hurst
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Talavera Road, North Ryde, NSW 2109, Australia; (L.W.); (M.K.); (L.H.)
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research, Heart Research Institute, Eliza Street, Newtown, NSW 2042, Australia;
- DVC Indigenous Office, University of New South Wales, High Street, Sydney, NSW 2052, Australia
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Croft AJ, Kelly C, Chen D, Haw TJ, Balachandran L, Murtha LA, Boyle AJ, Sverdlov AL, Ngo DTM. Sex-based differences in short- and longer-term diet-induced metabolic heart disease. Am J Physiol Heart Circ Physiol 2024; 326:H1219-H1251. [PMID: 38363215 DOI: 10.1152/ajpheart.00467.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
Sex-based differences in the development of obesity-induced cardiometabolic dysfunction are well documented, however, the specific mechanisms are not completely understood. Obesity has been linked to dysregulation of the epitranscriptome, but the role of N6-methyladenosine (m6A) RNA methylation has not been investigated in relation to the sex differences during obesity-induced cardiac dysfunction. In the current study, male and female C57BL/6J mice were subjected to short- and long-term high-fat/high-sucrose (HFHS) diet to induce obesogenic stress. Cardiac echocardiography showed males developed systolic and diastolic dysfunction after 4 mo of diet, but females maintained normal cardiac function despite both sexes being metabolically dysfunctional. Cardiac m6A machinery gene expression was differentially regulated by duration of HFHS diet in male, but not female mice, and left ventricular ejection fraction correlated with RNA machinery gene levels in a sex- and age-dependent manner. RNA-sequencing of cardiac transcriptome revealed that females, but not males may undergo protective cardiac remodeling early in the course of obesogenic stress. Taken together, our study demonstrates for the first time that cardiac RNA methylation machinery genes are regulated early during obesogenic stress in a sex-dependent manner and may play a role in the sex differences observed in cardiometabolic dysfunction.NEW & NOTEWORTHY Sex differences in obesity-associated cardiomyopathy are well documented but incompletely understood. We show for the first time that RNA methylation machinery genes may be regulated in response to obesogenic diet in a sex- and age-dependent manner and levels may correspond to cardiac systolic function. Our cardiac RNA-seq analysis suggests female, but not male mice may be protected from cardiac dysfunction by a protective cardiac remodeling response early during obesogenic stress.
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Affiliation(s)
- Amanda J Croft
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Conagh Kelly
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Dongqing Chen
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Tatt Jhong Haw
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Lohis Balachandran
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Lucy A Murtha
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Andrew J Boyle
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Aaron L Sverdlov
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Doan T M Ngo
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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Dong H, Sun Y, Nie L, Cui A, Zhao P, Leung WK, Wang Q. Metabolic memory: mechanisms and diseases. Signal Transduct Target Ther 2024; 9:38. [PMID: 38413567 PMCID: PMC10899265 DOI: 10.1038/s41392-024-01755-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/29/2024] Open
Abstract
Metabolic diseases and their complications impose health and economic burdens worldwide. Evidence from past experimental studies and clinical trials suggests our body may have the ability to remember the past metabolic environment, such as hyperglycemia or hyperlipidemia, thus leading to chronic inflammatory disorders and other diseases even after the elimination of these metabolic environments. The long-term effects of that aberrant metabolism on the body have been summarized as metabolic memory and are found to assume a crucial role in states of health and disease. Multiple molecular mechanisms collectively participate in metabolic memory management, resulting in different cellular alterations as well as tissue and organ dysfunctions, culminating in disease progression and even affecting offspring. The elucidation and expansion of the concept of metabolic memory provides more comprehensive insight into pathogenic mechanisms underlying metabolic diseases and complications and promises to be a new target in disease detection and management. Here, we retrace the history of relevant research on metabolic memory and summarize its salient characteristics. We provide a detailed discussion of the mechanisms by which metabolic memory may be involved in disease development at molecular, cellular, and organ levels, with emphasis on the impact of epigenetic modulations. Finally, we present some of the pivotal findings arguing in favor of targeting metabolic memory to develop therapeutic strategies for metabolic diseases and provide the latest reflections on the consequences of metabolic memory as well as their implications for human health and diseases.
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Affiliation(s)
- Hao Dong
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuezhang Sun
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lulingxiao Nie
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Aimin Cui
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Pengfei Zhao
- Periodontology and Implant Dentistry Division, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Wai Keung Leung
- Periodontology and Implant Dentistry Division, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Qi Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Wu T, Gong L, Zhang C, Zhang D, Li X. Three-dimensional echocardiography and strain cardiac imaging in patients with prediabetes and type 2 diabetes mellitus. Quant Imaging Med Surg 2023; 13:7753-7764. [PMID: 38106271 PMCID: PMC10722058 DOI: 10.21037/qims-23-560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/08/2023] [Indexed: 12/19/2023]
Abstract
Background Several studies using two-dimensional speckle tracking echocardiography (2D-STE) have confirmed the presence of left ventricular (LV) systolic dysfunction in patients with diabetes mellitus (DM), but there is a paucity of studies on whether three-dimensional (3D)-STE is superior to 2D-STE. The aim of this study was to evaluate the clinical value of 3D-STE in assessing subclinical LV systolic dysfunction in prediabetic and diabetic patients with preserved LV ejection fraction (LVEF) and to investigate the independent risk factors for this medical disorder. Methods This study included 40 diabetic patients, 35 prediabetic patients, and 33 healthy volunteers. All participants underwent LV peak systolic strain analysis using 3D- and 2D-STE, and the receiver operating characteristic (ROC) curve was constructed to determine the clinical diagnostic value of strain parameters for evaluating subclinical LV dysfunction in patients with prediabetes and type 2 DM (T2DM). Regression models were established to analyze independent risk factors for subclinical LV systolic dysfunction in patients with prediabetes and diabetes. Results The results of the 3D-STE-based analysis showed that the global longitudinal strain (GLS) of the control, prediabetic, and diabetic groups were (18.64%±2.43%, 15.21%±1.49%, and 13.49%±2.36%, respectively), global circumferential strain (GCS) was (18.09%±2.37%, 14.62%±1.75%, and 12.95%±2.20%, respectively), global area strain (GAS) was (31.30%±3.88%, 27.51%±3.31%, and 24.80%±3.86%, respectively), and global radial strain (GRS) was (49.18%±5.91%, 39.17%±4.55%, and 35.72%±7.19%, respectively). All 3D-STE global strain parameters gradually decreased from the controls, through the prediabetic group to the diabetic group, and there was statistical significance between the three groups (P<0.001). The area under the curve (AUC) of the 3D-STE global strain parameters (GLS, GCS, GAS, and GRS) were 0.898, 0.831, 0.863, and 0.868, respectively. The AUC of the 2D-STE global strain parameters (GLS and GCS) were 0.867 and 0.636, respectively. Multivariate regression analysis identified increased glycosylated hemoglobin A1c (HbA1c) and body mass index (BMI) as independent risk factors for subclinical LV systolic dysfunction. Conclusions Prediabetic and diabetic patients with preserved LVEF are at risk of subclinical LV systolic dysfunction. 3D-STE is a reliable imaging technique for evaluating early damage to LV myocardial mechanics. Early control of blood glucose (Glu) levels and weight can effectively prevent heart failure in the prediabetic and diabetic populations.
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Affiliation(s)
- Ting Wu
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lianggeng Gong
- Department of Medical Imaging Center, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chunquan Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dan Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xia Li
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Lechner K, Bock M, von Schacky C, Scherr J, Lorenz E, Lechner B, Haller B, Krannich A, Halle M, Wachter R, Duvinage A, Edelmann F. Trans-fatty acid blood levels of industrial but not natural origin are associated with cardiovascular risk factors in patients with HFpEF: a secondary analysis of the Aldo-DHF trial. Clin Res Cardiol 2023; 112:1541-1554. [PMID: 36640187 PMCID: PMC10584704 DOI: 10.1007/s00392-022-02143-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Industrially processed trans-fatty acids (IP-TFA) have been linked to altered lipoprotein metabolism, inflammation and increased NT-proBNP. In patients with heart failure with preserved ejection fraction (HFpEF), associations of TFA blood levels with patient characteristics are unknown. METHODS This is a secondary analysis of the Aldo-DHF-RCT. From 422 patients, individual blood TFA were analyzed at baseline in n = 404 using the HS-Omega-3-Index® methodology. Patient characteristics were: 67 ± 8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥ 50%, E/e' 7.1 ± 1.5; NT-proBNP 158 ng/L (IQR 82-298). A principal component analysis was conducted but not used for further analysis as cumulative variance for the first two PCs was low. Spearman's correlation coefficients as well as linear regression analyses, using sex and age as covariates, were used to describe associations of whole blood TFA with metabolic phenotype, functional capacity, echocardiographic markers for LVDF and neurohumoral activation at baseline and after 12 months. RESULTS Blood levels of the naturally occurring TFA C16:1n-7t were inversely associated with dyslipidemia, body mass index/truncal adiposity, surrogate markers for non-alcoholic fatty liver disease and inflammation at baseline/12 months. Conversely, IP-TFA C18:1n9t, C18:2n6tt and C18:2n6tc were positively associated with dyslipidemia and isomer C18:2n6ct with dysglycemia. C18:2n6tt and C18:2n6ct were inversely associated with submaximal aerobic capacity at baseline/12 months. No significant association was found between TFA and cardiac function. CONCLUSIONS In HFpEF patients, higher blood levels of IP-TFA, but not naturally occurring TFA, were associated with dyslipidemia, dysglycemia and lower functional capacity. Blood TFAs, in particular C16:1n-7t, warrant further investigation as prognostic markers in HFpEF. Higher blood levels of industrially processed TFA, but not of the naturally occurring TFA C16:1n-7t, are associated with a higher risk cardiometabolic phenotype and prognostic of lower aerobic capacity in patients with HFpEF.
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Affiliation(s)
- Katharina Lechner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Bock
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
| | | | - Johannes Scherr
- University Center for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Elke Lorenz
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Benjamin Lechner
- Department of Internal Medicine IV, Ludwig-Maximilians University, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Martin Halle
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Göttingen, Göttingen, Germany
| | - André Duvinage
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Frank Edelmann
- Department of Cardiology, Campus Virchow Klinikum (CVK), Charité, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.
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Cohen CD, De Blasio MJ, Farrugia GE, Dona MS, Hsu I, Prakoso D, Kiriazis H, Krstevski C, Nash DM, Li M, Gaynor TL, Deo M, Drummond GR, Ritchie RH, Pinto AR. Mapping the cellular and molecular landscape of cardiac non-myocytes in murine diabetic cardiomyopathy. iScience 2023; 26:107759. [PMID: 37736052 PMCID: PMC10509303 DOI: 10.1016/j.isci.2023.107759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/01/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023] Open
Abstract
Diabetes is associated with a significantly elevated risk of heart failure. However, despite extensive efforts to characterize the phenotype of the diabetic heart, the molecular and cellular protagonists that underpin cardiac pathological remodeling in diabetes remain unclear, with a notable paucity of data regarding the impact of diabetes on non-myocytes within the heart. Here we aimed to define key differences in cardiac non-myocytes between spontaneously type-2 diabetic (db/db) and healthy control (db/h) mouse hearts. Single-cell transcriptomic analysis revealed a concerted diabetes-induced cellular response contributing to cardiac remodeling. These included cell-specific activation of gene programs relating to fibroblast hyperplasia and cell migration, and dysregulation of pathways involving vascular homeostasis and protein folding. This work offers a new perspective for understanding the cellular mediators of diabetes-induced cardiac pathology, and pathways that may be targeted to address the cardiac complications associated with diabetes.
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Affiliation(s)
- Charles D. Cohen
- Cardiac Cellular Systems, Baker Heart and Diabetes Institute, Prahran, VIC, Australia
- Heart Failure Pharmacology, Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, Australia
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Bundoora, VIC, Australia
- Centre for Cardiovascular Biology and Disease Research, La Trobe University, Melbourne, VIC, Australia
| | - Miles J. De Blasio
- Heart Failure Pharmacology, Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, Australia
- Department of Pharmacology, Monash University, Clayton, VIC, Australia
| | - Gabriella E. Farrugia
- Cardiac Cellular Systems, Baker Heart and Diabetes Institute, Prahran, VIC, Australia
- Baker Department of Cardiovascular Research and Implementation, La Trobe University, Melbourne, VIC, Australia
| | - Malathi S.I. Dona
- Cardiac Cellular Systems, Baker Heart and Diabetes Institute, Prahran, VIC, Australia
| | - Ian Hsu
- Cardiac Cellular Systems, Baker Heart and Diabetes Institute, Prahran, VIC, Australia
| | - Darnel Prakoso
- Heart Failure Pharmacology, Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, Australia
| | - Helen Kiriazis
- Preclinical Cardiology, Microsurgery and Imaging Platform, Baker Heart and Diabetes Institute, Prahran, VIC, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, Australia
| | - Crisdion Krstevski
- Cardiac Cellular Systems, Baker Heart and Diabetes Institute, Prahran, VIC, Australia
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Bundoora, VIC, Australia
- Centre for Cardiovascular Biology and Disease Research, La Trobe University, Melbourne, VIC, Australia
| | - David M. Nash
- Heart Failure Pharmacology, Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, Australia
| | - Mandy Li
- Heart Failure Pharmacology, Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, Australia
| | - Taylah L. Gaynor
- Cardiac Cellular Systems, Baker Heart and Diabetes Institute, Prahran, VIC, Australia
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Bundoora, VIC, Australia
- Centre for Cardiovascular Biology and Disease Research, La Trobe University, Melbourne, VIC, Australia
| | - Minh Deo
- Heart Failure Pharmacology, Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, Australia
| | - Grant R. Drummond
- Centre for Cardiovascular Biology and Disease Research, La Trobe University, Melbourne, VIC, Australia
| | - Rebecca H. Ritchie
- Heart Failure Pharmacology, Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, Australia
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Bundoora, VIC, Australia
- Centre for Cardiovascular Biology and Disease Research, La Trobe University, Melbourne, VIC, Australia
| | - Alexander R. Pinto
- Cardiac Cellular Systems, Baker Heart and Diabetes Institute, Prahran, VIC, Australia
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Bundoora, VIC, Australia
- Centre for Cardiovascular Biology and Disease Research, La Trobe University, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, Australia
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Grigorescu ED, Lăcătușu CM, Floria M, Cazac GD, Onofriescu A, Sauciuc LA, Ceasovschih A, Crețu I, Mihai BM, Șorodoc L. Effects of Incretin-Based Treatment on the Diastolic (Dys)Function in Patients with Uncontrolled Type 2 Diabetes Mellitus: A Prospective Study with 1-Year Follow-Up. Diagnostics (Basel) 2023; 13:2817. [PMID: 37685355 PMCID: PMC10487011 DOI: 10.3390/diagnostics13172817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/19/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Left ventricular diastolic dysfunction (DD) is a subclinical cardiac abnormality in patients with type 2 diabetes mellitus (T2DM) that can progress to heart failure (HF) and increase cardiovascular risk. This prospective study evaluated the DD in T2DM patients without atherosclerotic cardiovascular disease after one year of incretin-based drugs added to standard treatment. Of the 138 enrolled patients (49.30% male, mean age 57.86 ± 8.82, mean T2DM history 5 years), 71 were started on dipeptidyl peptidase-4 inhibitor sitagliptin/saxagliptin, 21 on glucagon-like peptide-1 receptor agonist exenatide, and 46 formed the control group (metformin and sulphonylurea/acarbose). At baseline, 71 patients had grade 1 DD, another 12 had grade 2 and 3 DD, and 15 had indeterminate DD. After one year, DD was evidenced in 50 cases. Diastolic function improved in 9 cases, and 27 patients went from grade 1 to indeterminate DD. The active group benefited more, especially patients treated with exenatide; their metabolic and inflammation profiles also improved the most. An in-depth analysis of echocardiographic parameters and paraclinical results in the context of literature data justifies the conclusion that early assessment of diastolic function in T2DM patients is necessary and the benefits of affordable incretin-based treatment may extend to subclinical cardiovascular manifestations such as DD.
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Affiliation(s)
- Elena-Daniela Grigorescu
- Unit of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (E.-D.G.); (A.O.); (B.-M.M.)
| | - Cristina-Mihaela Lăcătușu
- Unit of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (E.-D.G.); (A.O.); (B.-M.M.)
- Clinical Center of Diabetes, Nutrition and Metabolic Diseases, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Mariana Floria
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.F.); (A.C.); (L.Ș.)
- Medical Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Georgiana-Diana Cazac
- Unit of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (E.-D.G.); (A.O.); (B.-M.M.)
- Clinical Center of Diabetes, Nutrition and Metabolic Diseases, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Alina Onofriescu
- Unit of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (E.-D.G.); (A.O.); (B.-M.M.)
- Clinical Center of Diabetes, Nutrition and Metabolic Diseases, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Livia-Amira Sauciuc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Alexandr Ceasovschih
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.F.); (A.C.); (L.Ș.)
- Medical Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Ioana Crețu
- Crețu R. Ioana PFA, 1 Mărului, 707020 Aroneanu, Romania;
| | - Bogdan-Mircea Mihai
- Unit of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (E.-D.G.); (A.O.); (B.-M.M.)
- Clinical Center of Diabetes, Nutrition and Metabolic Diseases, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Laurențiu Șorodoc
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.F.); (A.C.); (L.Ș.)
- Medical Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
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8
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Liberty IA, Septadina IS, Rizqie MQ, Ananingsih ES, Hasyim H, Sitorus RJ. Predictors of Prediabetes Among Communities Without a Family History of Type 2 Diabetes Mellitus: A Case-Control Study. Cureus 2023; 15:e44131. [PMID: 37753042 PMCID: PMC10518250 DOI: 10.7759/cureus.44131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Background Prediabetes is the golden period to promote, prevent, or delay diabetes mellitus (DM) conversion. This study aims to assess the risk predictors associated with prediabetes among communities without a family history of type 2 DM (T2DM). Methodology This case-control study involved 570 participants (265 prediabetes cases and the same number of age-matched controls) in Palembang, Indonesia. Each participant is willing to take fasting blood glucose, lipid profile tests, and physical examinations. Results Multivariate analysis of this study revealed that significant risk predictors identified were occupation in the informal sector (aOR = 3.28; 95% CI = 1.64-6.58; p-value = 0.001), diastolic blood pressure of 80-89 mmHg (aOR = 2.18; 95% CI = 1.35-3.52; p-value = 0.001), diastolic blood pressure of 90-99 mmHg (aOR = 2.09; 95% CI= 1.15-3.82; p-value = 0.016), with an aOR = 5.80 (95% CI= 3.71-9.05; p-value <0.001). triglyceride-glucose index was the dominant risk predictor for prediabetes. Conclusions Knowing who is most vulnerable can guide the efficient allocation of promotion and prevention resources. This finding proves essential consideration for health promoters emphasizing a healthy diet and lifestyle by maintaining diastolic pressure and triglyceride glucose (TyG) index while considering the occupation in populations without a family history of T2DM.
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Affiliation(s)
- Iche A Liberty
- Biomedicine, Universitas Sriwijaya, Palembang, IDN
- Public Health and Community Medicine, Universitas Sriwijaya, Palembang, IDN
| | | | | | - Esti S Ananingsih
- Epidemiology, Ministry of Health Palembang Health Polytecnic, Palembang, IDN
| | - Hamzah Hasyim
- Public Health, Universitas Sriwijaya, Palembang, IDN
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9
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Wójcicka G, Pradiuch A, Fornal E, Stachniuk A, Korolczuk A, Marzec-Kotarska B, Nikolaichuk H, Czechowska G, Kozub A, Trzpil A, Góralczyk A, Bełtowski J. The effect of exenatide (a GLP-1 analogue) and sitagliptin (a DPP-4 inhibitor) on asymmetric dimethylarginine (ADMA) metabolism and selected biomarkers of cardiac fibrosis in rats with fructose-induced metabolic syndrome. Biochem Pharmacol 2023:115637. [PMID: 37290595 DOI: 10.1016/j.bcp.2023.115637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide (NO) synthesis, is a risk factor for endothelial dysfunction, a common pathophysiological denominator for both atherogenesis and cardiac fibrosis. We aimed to investigate whether the cardioprotective and antifibrotic effects of incretin drugs, exenatide and sitagliptin, may be associated with their ability to affect circulating and cardiac ADMA metabolism. Normal and fructose-fed rats were treated with sitagliptin (5.0/10 mg/kg) or exenatide (5/10 µg/kg) for 4 weeks. The following methods were used: LC-MS/MS, ELISA, Real-Time-PCR, colorimetry, IHC and H&E staining, PCA and OPLS-DA projections. Eight-week fructose feeding resulted in an increase in plasma ADMA and a decrease in NO concentration. Exenatide administration into fructose-fed rats reduced the plasma ADMA level and increased NO level. In the heart of these animals exenatide administration increased NO and PRMT1 level, reduced TGF-ß1, α-SMA levels and COL1A1 expression. In the exenatide treated rats renal DDAH activity positively correlated with plasma NO level and negatively with plasma ADMA level and cardiac α-SMA concentration. Sitagliptin treatment of fructose-fed rats increased plasma NO concentration, reduced circulating SDMA level, increased renal DDAH activity and reduced myocardial DDAH activity. Both drugs attenuated the myocardial immunoexpression of Smad2/3/P and perivascular fibrosis. In the metabolic syndrome condition both sitagliptin and exenatide positively modulated cardiac fibrotic remodeling and circulating level of endogenous NOS inhibitors but had no effects on ADMA levels in the myocardium.
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Affiliation(s)
- G Wójcicka
- Department of Pathophysiology, Medical University of Lublin, ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
| | - A Pradiuch
- Department of Pathophysiology, Medical University of Lublin, ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
| | - E Fornal
- Department of Bioanalytic, Medical University of Lublin ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
| | - A Stachniuk
- Department of Bioanalytic, Medical University of Lublin ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
| | - A Korolczuk
- Department of Clinical Pathology, Medical University of Lublin, ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
| | - B Marzec-Kotarska
- Department of Clinical Pathology, Medical University of Lublin, ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
| | - H Nikolaichuk
- Department of Bioanalytic, Medical University of Lublin, ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
| | - G Czechowska
- Department of Pharmacology, Medical University of Lublin, ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
| | - A Kozub
- Department of Bioanalytic, Medical University of Lublin, ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
| | - A Trzpil
- Department of Bioanalytic, Medical University of Lublin, ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
| | - A Góralczyk
- Department of Pathophysiology, Medical University of Lublin, ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
| | - J Bełtowski
- Department of Pathophysiology, Medical University of Lublin, ul. Jaczewskiego 8b, 20-090 Lublin, Poland.
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10
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Left atrial strain evaluation to assess left ventricle diastolic dysfunction and heart failure with preserved ejection fraction: a guide to clinical practice : Left atrial strain and diastolic function. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1083-1096. [PMID: 36826616 DOI: 10.1007/s10554-023-02816-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/11/2023] [Indexed: 02/25/2023]
Abstract
Although frequently unrecognized, left atrium (LA) function plays a key role in global cardiac performance as it modulates left ventricle (LV) filling through three main functions: the LA reservoir, conduit and booster pump. Given the interdependence between the LA and the LV, it is known that LA dimension and/or LA function can be used as a surrogate for LV diastolic function.Recently, LA deformation analysis using 2-dimensional (2D) speckle tracking echocardiography (STE) strain emerged as a promising non-invasive technique that can help to estimate LV filling pressures (LVFP) and diagnose heart failure with preserved ejection fraction (HFpEF), as recently proposed in the recent 2022 European Association of Cardiovascular Imaging (EACVI) consensus which included LA reservoir strain as an additive parameter to estimate LVFP.This article aims to review the latest evidence regarding the role of LA strain in the assessment and management of LV diastolic dysfunction (LVDD) and HFpEF, providing a clinical guide with tips and tricks to use LA strain as a new technique to help to estimate LVFP.
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11
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Hao J, Liu Y. Epigenetics of methylation modifications in diabetic cardiomyopathy. Front Endocrinol (Lausanne) 2023; 14:1119765. [PMID: 37008904 PMCID: PMC10050754 DOI: 10.3389/fendo.2023.1119765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/01/2023] [Indexed: 03/17/2023] Open
Abstract
Type 2 diabetes is one of the most common metabolic diseases with complications including diabetic cardiomyopathy and atherosclerotic cardiovascular disease. Recently, a growing body of research has revealed that the complex interplay between epigenetic changes and the environmental factors may significantly contribute to the pathogenesis of cardiovascular complications secondary to diabetes. Methylation modifications, including DNA methylation and histone methylation among others, are important in developing diabetic cardiomyopathy. Here we summarized the literatures of studies focusing on the role of DNA methylation, and histone modifications in microvascular complications of diabetes and discussed the mechanism underlying these disorders, to provide the guidance for future research toward an integrated pathophysiology and novel therapeutic strategies to treat or prevent this frequent pathological condition.
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Affiliation(s)
- Jing Hao
- Department of Emergency, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Yao Liu
- Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Yao Liu,
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12
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Cardiometabolic-based chronic disease: adiposity and dysglycemia drivers of heart failure. Heart Fail Rev 2023; 28:47-61. [PMID: 35368233 DOI: 10.1007/s10741-022-10233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
Heart failure (HF) is a complex clinical syndrome, associated with high rates of mortality, hospitalization, and impairment of quality of life. Obesity and type 2 diabetes are major cardiometabolic drivers, represented as distinct stages of adiposity- and dysglycemia-based chronic disease (ABCD, DBCD), respectively, and leading to cardiometabolic-based chronic disease (CMBCD). This review focuses on one aspect of the CMBCD model: how ABCD and DBCD influence genesis and progression of HF phenotypes. Specifically, the relationships of ABCD and DBCD stages with structural and functional heart disease, HF risk, and outcomes in overt HF are detailed. Also, evidence-based lifestyle, pharmacological, and procedural interventions that promote or reverse cardiac remodeling and outcomes in individuals at risk or with HF are discussed. In summary, driver-based chronic disease models for individuals at risk or with HF can expose prevention targets for more comprehensive interventions to improve clinical outcomes. Future randomized trials that investigate structured lifestyle, pharmacological, and procedural therapies specifically tailored for the CMBCD model are needed to develop personalized care plans to decrease HF susceptibility and improve outcomes.
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13
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Guria RT, Prasad MK, Mishra B, Marandi S, Kumar A, Dungdung A. Association of Glycosylated Haemoglobin (HbA1c) Level With Left Ventricular Diastolic Dysfunction in Patients With Type 2 Diabetes. Cureus 2022; 14:e31626. [PMCID: PMC9672388 DOI: 10.7759/cureus.31626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 11/19/2022] Open
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14
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Yang J, Song J, Zhou J, Lin H, Wu Z, Liu N, Xie W, Guo H, Chi J. Functional components of Chinese rice wine can ameliorate diabetic cardiomyopathy through the modulation of autophagy, apoptosis, gut microbiota, and metabolites. Front Cardiovasc Med 2022; 9:940663. [PMID: 36186976 PMCID: PMC9515449 DOI: 10.3389/fcvm.2022.940663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Dietary polyphenols, polypeptides, and oligosaccharides modulate inflammation and immunity by altering the composition of gut microbiota. The polyphenols and polypeptides in Chinese rice wine have protective effects against cardiovascular disease. In this study, we hypothesized that the polyphenols, polypeptides, and oligosaccharides in Chinese rice wine can ameliorate diabetic cardiomyopathy (DCM) by altering gut microbiota and metabolites. Methods Mice with DCM and high glucose cells were treated with rice wine polyphenols (RWPH), rice wine polypeptides (RWPE), and rice wine oligosaccharides. Cardiac function was evaluated by echocardiography and detection of myocardial injury markers. We observed the pathological structures using hematoxylin and eosin staining, Masson's trichrome staining, and transmission electron microscopy. The expression levels of autophagy-related proteins and stubRFP-sensGFP-LC3 fluorescence were measured to evaluate autophagy. We performed TUNEL staining and measured the levels of Bax, Bcl-2, and p53 to assess apoptosis. To analyze the effects of the rice wine functional components on the gut microbiota and metabolites of DCM mice, we performed fecal 16S-rDNA gene sequencing and serum untargeted metabolomics. Results Our results showed an increase in cardiac and mitochondrial function, promotion of autophagy, and inhibition of cardiomyocyte apoptosis, which indicates that RWPH and RWPE can ameliorate DCM. The abundance of Akkermansia and Desulfovibrio were reduced by the presence of RWPH and RWPE. The growth of the Lachnospiraceae_NK4A136_group and Clostridiales-unclassified were promoted by the presence of RWPH. Tryptophan metabolism-associated metabolites were increased and phenylalanine levels were reduced by the presence of RWPH and RWPE. The biosynthesis of primary bile acids was enhanced by the presence of RWPH. Conclusion Both RWPH and RWPE provided a protective effect against DCM by promoting autophagy, inhibiting apoptosis, and reversing both gut microbiota dysbiosis and metabolic dysregulation.
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Affiliation(s)
- Jinjin Yang
- Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Jiaoying Song
- Medical College of Shaoxing University, Shaoxing, China
| | - Jiedong Zhou
- Medical College of Shaoxing University, Shaoxing, China
| | - Hui Lin
- Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Zhuonan Wu
- Medical College of Shaoxing University, Shaoxing, China
| | - Nan Liu
- Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenqing Xie
- Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hangyuan Guo
- Medical College of Shaoxing University, Shaoxing, China
| | - Jufang Chi
- Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
- *Correspondence: Jufang Chi
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15
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Ai S, Wang X, Wang S, Zhao Y, Guo S, Li G, Chen Z, Lin F, Guo S, Li Y, Zhang J, Zhao G. Effects of glycemic traits on left ventricular structure and function: a mendelian randomization study. Cardiovasc Diabetol 2022; 21:109. [PMID: 35715813 PMCID: PMC9206364 DOI: 10.1186/s12933-022-01540-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/01/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Adverse ventricular structure and function is a key pathogenic mechanism of heart failure. Observational studies have shown that both insulin resistance (IR) and glycemic level are associated with adverse ventricular structure and function. However, whether IR and glycemic level are causally associated with cardiac structure and function remains unclear. METHODS Genetic variants for IR, fasting insulin, HbA1c, and fasting glucose were selected based on published genome-wide association studies, which included 188,577, 108,557, 123,665, and 133,010 individuals of European ancestry, respectively. Outcome datasets for left ventricular (LV) parameters were obtained from UK Biobank Cardiovascular Magnetic Resonance sub-study (n = 16,923). Mendelian randomization (MR) analyses with the inverse-variance weighted (IVW) method were used for the primary analyses, while weighted median, MR-Egger, and MR-PRESSO were used for sensitivity analyses. Multivariable MR analyses were also conducted to examine the independent effects of glycemic traits on LV parameters. RESULTS In the primary IVW MR analyses, per 1-standard deviation (SD) higher IR was significantly associated with lower LV end-diastolic volume (β = - 0.31 ml, 95% confidence interval [CI] - 0.48 to - 0.14 ml; P = 4.20 × 10-4), lower LV end-systolic volume (β = - 0.34 ml, 95% CI - 0.51 to - 0.16 ml; P = 1.43 × 10-4), and higher LV mass to end-diastolic volume ratio (β = 0.50 g/ml, 95% CI 0.32 to 0.67 g/ml; P = 6.24 × 10-8) after Bonferroni adjustment. However, no associations of HbA1c and fasting glucose were observed with any LV parameters. Results from sensitivity analyses were consistent with the main findings, but with a slightly attenuated estimate. Multivariable MR analyses provided further evidence for an independent effect of IR on the adverse changes in LV parameters after controlling for HbA1c. CONCLUSIONS Our study suggests that genetic liability to IR rather than those of glycemic levels are associated with adverse changes in LV structure and function, which may strengthen our understanding of IR as a risk factor for heart failure by providing evidence of direct impact on cardiac morphology.
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Affiliation(s)
- Sizhi Ai
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Xiaoyu Wang
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Shanshan Wang
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Yilin Zhao
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Shuxun Guo
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Guohua Li
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Zhigang Chen
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Fei Lin
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Sheng Guo
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Yan Li
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Jihui Zhang
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China. .,Guangdong Mental Health Center, Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China. .,Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
| | - Guoan Zhao
- Department of Cardiology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China.
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16
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Thanaj M, Mielke J, McGurk KA, Bai W, Savioli N, de Marvao A, Meyer HV, Zeng L, Sohler F, Lumbers RT, Wilkins MR, Ware JS, Bender C, Rueckert D, MacNamara A, Freitag DF, O'Regan DP. Genetic and environmental determinants of diastolic heart function. NATURE CARDIOVASCULAR RESEARCH 2022; 1:361-371. [PMID: 35479509 PMCID: PMC7612636 DOI: 10.1038/s44161-022-00048-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Diastole is the sequence of physiological events that occur in the heart during ventricular filling and principally depends on myocardial relaxation and chamber stiffness. Abnormal diastolic function is related to many cardiovascular disease processes and is predictive of health outcomes, but its genetic architecture is largely unknown. Here, we use machine learning cardiac motion analysis to measure diastolic functional traits in 39,559 participants of the UK Biobank and perform a genome-wide association study. We identified 9 significant, independent loci near genes that are associated with maintaining sarcomeric function under biomechanical stress and genes implicated in the development of cardiomyopathy. Age, sex and diabetes were independent predictors of diastolic function and we found a causal relationship between genetically-determined ventricular stiffness and incident heart failure. Our results provide insights into the genetic and environmental factors influencing diastolic function that are relevant for identifying causal relationships and potential tractable targets.
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Affiliation(s)
- Marjola Thanaj
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Johanna Mielke
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | - Kathryn A McGurk
- MRC London Institute of Medical Sciences, Imperial College London, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Wenjia Bai
- Department of Computing, Imperial College London, London, UK.,Department of Brain Sciences, Imperial College London
| | - Nicolò Savioli
- MRC London Institute of Medical Sciences, Imperial College London, London, UK.,Department of Computing, Imperial College London, London, UK
| | - Antonio de Marvao
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Hannah V Meyer
- Cold Spring Harbor Laboratory, Simons Center for Quantitative Biology, USA
| | - Lingyao Zeng
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | - Florian Sohler
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | | | - Martin R Wilkins
- National Heart and Lung Institute, Imperial College London, London, UK
| | - James S Ware
- MRC London Institute of Medical Sciences, Imperial College London, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Christian Bender
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, UK.,Institute for Artificial Intelligence and Informatics, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Aidan MacNamara
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | - Daniel F Freitag
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
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17
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Selemon NA, Gu A, Malahias MA, Fassihi SC, Chen AZ, Adriani M, Sculco TP, Liu J, Cross MB, Sculco PK. Insulin-dependent diabetes mellitus is an independent risk factor for postoperative complications in aseptic revision total hip arthroplasty. Hip Int 2022; 32:213-220. [PMID: 32750266 DOI: 10.1177/1120700020945221] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Revision total hip arthroplasty (rTHA) is becoming a more common procedure due to the increasing volume of primary total hip arthroplasty. Diabetes mellitus (DM) is currently projected to affect 4.4% of the global population by 2030. Diabetes has been associated with poor outcomes for a variety of surgical interventions. However, the impact of insulin dependence has yet to be fully understood. The aim of this study was to determine the impact of insulin dependence on acute postoperative complications following rTHA. METHODS A retrospective cohort study was conducted using the American College of Surgeons National Quality Improvement Program database. All patients who underwent rTHA between 2006 and 2016 were identified and recorded as having non-insulin-dependent DM (NIDDM), insulin-dependent DM (IDDM) or no DM. Univariate and multivariate analysis were used to evaluate the incidence of multiple adverse events within 30 days after rTHA. RESULTS A total of 7685 patients were evaluated (No DM = 6651, NIDDM = 700, IDDM = 334). Univariate analysis revealed that all patients with DM had significantly higher incidences of postoperative complications (NIDDM: p < 0.001; IDDM: p < 0.001) and extended hospital length of stay (NIDDM: p = 0.015; IDDM: p < 0.0001). NIDDM was associated with increased rates of superficial surgical site infection (SSI) (p = 0.001), deep SSI (p = 0.038), and stroke (p = 0.013), while IDDM was associated with increased rates of pneumonia (p < 0.001), renal failure (p < 0.001), and postoperative transfusion (p < 0.001). On multivariate analysis, insulin-dependence was determined to be an independent risk factor for extended hospital length of stay (OR 1.905; 95% CI, 1.410-2.577; p < 0.001), pneumonia (OR 4.016; 95% CI, 1.799-8.929; p = 0.001), renal failure (OR 7.143; 95% CI, 2.203-23.256; p = 0.001) and postoperative transfusion (OR 1.366; 95% CI, 1.076-1.733; p = 0.01). CONCLUSIONS Insulin dependence is an independent risk factor for numerous short-term postoperative complications following rTHA. When assessing risk and planning perioperative management, surgeons should consider insulin-dependent diabetics as a sub-cohort within the diabetic population.
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Affiliation(s)
- Nicolas A Selemon
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Alex Gu
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA.,Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, USA
| | - Michael-Alexander Malahias
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Safa Cyrus Fassihi
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, USA
| | | | - Marco Adriani
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Thomas P Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Jiabin Liu
- Department of Anaesthesia, Hospital for Special Surgery, New York, USA
| | - Michael B Cross
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
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18
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Abdelaaty T, Morsy E, Rizk M, Shokry A, Abdelhameid A, Fathalla R. Relation of serum heart type fatty acid binding protein to left ventricular diastolic dysfunction in patients with type 2 diabetes and early diabetic kidney disease. J Diabetes Complications 2022; 36:108122. [PMID: 35123867 DOI: 10.1016/j.jdiacomp.2021.108122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/26/2021] [Accepted: 12/28/2021] [Indexed: 11/21/2022]
Abstract
AIMS We aimed to investigate the serum level of heart type fatty acid binding protein (H-FABP) and its relation to left ventricular (LV) diastolic dysfunction in patients with type 2 diabetes (T2DM) and early diabetic kidney disease (DKD). METHODS This study was conducted on 100 T2DM patients divided into 50 patients with early DKD and 50 patients without DKD. Doppler echocardiography was used to assess LV function and serum H-FABP levels were measured using ELISA technique. RESULTS 78% of patients with DKD and 12% of patients without DKD had LV diastolic dysfunction. Among patients with DKD, those with diastolic dysfunction had significantly higher urinary albumin to creatinine ratio (UACR) (p = 0.041). H-FABP levels were significantly higher in patients with DKD (p˂0.001) and it had significant positive correlation with UACR (p = 0.009). No significant difference was found regarding serum H-FABP levels between patients with normal LV function and those with diastolic dysfunction in both study groups. CONCLUSION Diastolic dysfunction is a common finding among patients with T2DM. UACR, but not serum H-FABP, is significantly associated with diastolic dysfunction in patients with early DKD. Serum H-FABP level is significantly higher in early DKD and positively correlated with the level of albuminuria.
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Affiliation(s)
- Talaat Abdelaaty
- Diabetes and Metabolism Unit, Internal Medicine Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Eman Morsy
- Diabetes and Metabolism Unit, Internal Medicine Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Mohamed Rizk
- Clinical and Chemical Pathology Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Ahmed Shokry
- Cardiology Department, Alexandria Armed Forces Hospital, Military Medical Academy, Egypt
| | - Ahmed Abdelhameid
- Internal Medicine Department, Alexandria Armed Forces Hospital, Alexandria, Egypt
| | - Reem Fathalla
- Diabetes and Metabolism Unit, Internal Medicine Department, Alexandria University Faculty of Medicine, Alexandria, Egypt.
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Short-Chain Carbon Sources. JACC Basic Transl Sci 2022; 7:730-742. [PMID: 35958686 PMCID: PMC9357564 DOI: 10.1016/j.jacbts.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022]
Abstract
Heart failure (HF) remains the leading cause of morbidity and mortality in the developed world, highlighting the urgent need for novel, effective therapeutics. Recent studies support the proposition that improved myocardial energetics as a result of ketone body (KB) oxidation may account for the intriguing beneficial effects of sodium-glucose cotransporter-2 inhibitors in patients with HF. Similar small molecules, short-chain fatty acids (SCFAs) are now realized to be preferentially oxidized over KBs in failing hearts, contradicting the notion of KBs as a rescue "superfuel." In addition to KBs and SCFAs being alternative fuels, both exert a wide array of nonmetabolic functions, including molecular signaling and epigenetics and as effectors of inflammation and immunity, blood pressure regulation, and oxidative stress. In this review, the authors present a perspective supported by new evidence that the metabolic and unique nonmetabolic activities of KBs and SCFAs hold promise for treatment of patients with HF with reduced ejection fraction and those with HF with preserved ejection fraction.
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Aslan B, Akyüz A, Işık F, Boyraz B, İnci Ü, Yıldız H, Çap M, Karahan MZ, Araç E, Okşul M, Kaya İ. The effect of empagliflozin on p wave peak time and other p wave parameters in patients with diabetes mellitus. Pacing Clin Electrophysiol 2022; 45:323-329. [PMID: 35175628 DOI: 10.1111/pace.14463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/26/2022] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Empagliflozin is a selective SGLT2 inhibitor and provides a significant reduction in hospitalizations in HF patients and a reduction in combined cardiovascular deaths regardless of diabetes. The mechanisms of favorable effects remain unclear. Improvement in left ventricular diastolic function and a decrease in filling pressure are any mechanisms of positive effects. These effects may show themselves with some changes on the ECG. So, we aimed to evaluate the effect of empagliflozin on P wave parameters in type 2 diabetes mellitus patients without heart failure. METHOD Fifty-three patients were included in the study. The electrocardiographic and echocardiographic evaluations were examined at the baseline and end of the 3rd month for all patients. RESULTS The median age of all patients was 55 (45-64 IOR). After treatment, LA volume (p 0.001) and diameter (p=0.001) in both the parasternal long-axis (p=0.001) and the apical four-chamber view decreased. E/e' and sPAP were significantly decreased after treatment. PWDmax, PWDmin, and PWdis (p=0.017) were significantly shorter after treatment. The PWPT in lead Dıı and V1 were significantly shorter after treatment. CONCLUSION We found shortening of PWPT, PWdis, and PWD as reflections of improvements in LA volume and LV diastolic function on ECG after empagliflozin treatment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Burhan Aslan
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Turkey
| | - Abdurrahman Akyüz
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Turkey
| | - Ferhat Işık
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Turkey
| | | | - Ümit İnci
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Turkey
| | - Halil Yıldız
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Turkey
| | - Murat Çap
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Turkey
| | - Mehmet Zülküf Karahan
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Turkey
| | - Eşref Araç
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of General Medicine and Endocrine, Turkey
| | - Metin Okşul
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Turkey
| | - İlyas Kaya
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Health and Science University, Department of Cardiology, Turkey
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Kadowaki T, Komuro I, Morita N, Akiyama H, Kidani Y, Yajima T. Manifestation of Heart Failure and Chronic Kidney Disease are Associated with Increased Mortality Risk in Early Stages of Type 2 Diabetes Mellitus: Analysis of a Japanese Real-World Hospital Claims Database. Diabetes Ther 2022; 13:275-286. [PMID: 35006534 PMCID: PMC8873323 DOI: 10.1007/s13300-021-01191-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/07/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION To assess the initial manifestation of comorbidities and their impact on mortality risk in patients with type 2 diabetes mellitus (T2DM) without a history of cardiovascular or renal complications (i.e., in the early stages of T2DM) compared with patients without T2DM. METHODS We performed a retrospective cohort study using a Japanese hospital claims database. The incidence rates of comorbidities (chronic kidney disease [CKD], heart failure [HF], myocardial infarction [MI], peripheral arterial disease [PAD], and stroke) and mortality risk were compared between patients with T2DM and age-/sex-matched patients without T2DM (matched 1:2). RESULTS Among the comorbidities assessed in this study, CKD and/or HF was the most frequent initial manifestation in the patients with T2DM (n = 426,186) with an incidence rate 2.02 times greater than that in matched patients without T2DM (n = 1,018,609). The mortality risk was also greater in patients with T2DM than in patients without T2DM with a hazard ratio of 1.73. In both patients with and without T2DM, the presence of CKD or HF was associated with greater mortality risks compared with the presence of MI, PAD, or stroke. CONCLUSIONS The high incidence of CKD or HF manifestation can contribute to the augmented mortality risk in patients in the early stages of T2DM compared with patients without T2DM. These findings highlight the importance of early interventions for preventing/treating CKD and HF to improve the prognosis of patients with T2DM.
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Affiliation(s)
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Naru Morita
- Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Tower B Grand Front Osaka, 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Hiroki Akiyama
- Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Tower B Grand Front Osaka, 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Yoko Kidani
- Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Tower B Grand Front Osaka, 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan
| | - Toshitaka Yajima
- Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Tower B Grand Front Osaka, 3-1 Ofukacho, Kita-ku, Osaka, 530-0011, Japan.
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22
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Deng J, Liao Y, Liu J, Liu W, Yan D. Research Progress on Epigenetics of Diabetic Cardiomyopathy in Type 2 Diabetes. Front Cell Dev Biol 2022; 9:777258. [PMID: 35004678 PMCID: PMC8740193 DOI: 10.3389/fcell.2021.777258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022] Open
Abstract
Diabetic cardiomyopathy (DCM) is characterized by diastolic relaxation abnormalities in its initial stages and by clinical heart failure (HF) without dyslipidemia, hypertension, and coronary artery disease in its last stages. DCM contributes to the high mortality and morbidity rates observed in diabetic populations. Diabetes is a polygenic, heritable, and complex condition that is exacerbated by environmental factors. Recent studies have demonstrated that epigenetics directly or indirectly contribute to pathogenesis. While epigenetic mechanisms such as DNA methylation, histone modifications, and non-coding RNAs, have been recognized as key players in the pathogenesis of DCM, some of their impacts remain not well understood. Furthering our understanding of the roles played by epigenetics in DCM will provide novel avenues for DCM therapeutics and prevention strategies.
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Affiliation(s)
- Jianxin Deng
- Department of Endocrinology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University; Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen, China
| | - Yunxiu Liao
- Health Science Center of Shenzhen University, Shenzhen, China
| | - Jianpin Liu
- Health Science Center of Shenzhen University, Shenzhen, China
| | - Wenjuan Liu
- Health Science Center of Shenzhen University, Shenzhen, China
| | - Dewen Yan
- Department of Endocrinology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center of Shenzhen University; Shenzhen Clinical Research Center for Metabolic Diseases, Shenzhen, China
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The Number of Frames on ECG-Gated 18F-FDG Small Animal PET Has a Significant Impact on LV Systolic and Diastolic Functional Parameters. Mol Imaging 2022; 2021:4629459. [PMID: 34987313 PMCID: PMC8694669 DOI: 10.1155/2021/4629459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives This study is aimed at investigating the impact of frame numbers in preclinical electrocardiogram- (ECG-) gated 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) on systolic and diastolic left ventricular (LV) parameters in rats. Methods 18F-FDG PET imaging using a dedicated small animal PET system with list mode data acquisition and continuous ECG recording was performed in diabetic and control rats. The list-mode data was sorted and reconstructed with different numbers of frames (4, 8, 12, and 16) per cardiac cycle into tomographic images. Using an automatic ventricular edge detection software, left ventricular (LV) functional parameters, including ejection fraction (EF), end-diastolic (EDV), and end-systolic volume (ESV), were calculated. Diastolic variables (time to peak filling (TPF), first third mean filling rate (1/3 FR), and peak filling rate (PFR)) were also assessed. Results Significant differences in multiple parameters were observed among the reconstructions with different frames per cardiac cycle. EDV significantly increased by numbers of frames (353.8 ± 57.7 μl∗, 380.8 ± 57.2 μl∗, 398.0 ± 63.1 μl∗, and 444.8 ± 75.3 μl at 4, 8, 12, and 16 frames, respectively; ∗P < 0.0001 vs. 16 frames), while systolic (EF) and diastolic (TPF, 1/3 FR and PFR) parameters were not significantly different between 12 and 16 frames. In addition, significant differences between diabetic and control animals in 1/3 FR and PFR in 16 frames per cardiac cycle were observed (P < 0.005), but not for 4, 8, and 12 frames. Conclusions Using ECG-gated PET in rats, measurements of cardiac function are significantly affected by the frames per cardiac cycle. Therefore, if you are going to compare those functional parameters, a consistent number of frames should be used.
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Ca 2+ mishandling and mitochondrial dysfunction: a converging road to prediabetic and diabetic cardiomyopathy. Pflugers Arch 2022; 474:33-61. [PMID: 34978597 PMCID: PMC8721633 DOI: 10.1007/s00424-021-02650-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 12/16/2022]
Abstract
Diabetic cardiomyopathy is defined as the myocardial dysfunction that suffers patients with diabetes mellitus (DM) in the absence of hypertension and structural heart diseases such as valvular or coronary artery dysfunctions. Since the impact of DM on cardiac function is rather silent and slow, early stages of diabetic cardiomyopathy, known as prediabetes, are poorly recognized, and, on many occasions, cardiac illness is diagnosed only after a severe degree of dysfunction was reached. Therefore, exploration and recognition of the initial pathophysiological mechanisms that lead to cardiac dysfunction in diabetic cardiomyopathy are of vital importance for an on-time diagnosis and treatment of the malady. Among the complex and intricate mechanisms involved in diabetic cardiomyopathy, Ca2+ mishandling and mitochondrial dysfunction have been described as pivotal early processes. In the present review, we will focus on these two processes and the molecular pathway that relates these two alterations to the earlier stages and the development of diabetic cardiomyopathy.
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25
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Al-Gburi AJ. Left ventricular diastolic reserve by exercise stress echocardiography in prediabetes. Tzu Chi Med J 2022. [DOI: 10.4103/tcmj.tcmj_151_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Otowa‐Suematsu N, Sakaguchi K, Kaneko A, Ito J, Morita Y, Miura H, Yamada T, So A, Komada H, Okada Y, Hirota Y, Tamori Y, Ogawa W. Relation of cardiac function to insulin resistance as evaluated by hyperinsulinemic-euglycemic clamp analysis in individuals with type 2 diabetes. J Diabetes Investig 2021; 12:2197-2202. [PMID: 34081831 PMCID: PMC8668073 DOI: 10.1111/jdi.13608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 01/01/2023] Open
Abstract
AIMS Whereas homeostasis model assessment of insulin resistance (HOMA-IR), an easily measured but limited index of insulin resistance, has been shown to correlate with impairment of cardiac function in individuals without diabetes, the pathological relevance of insulin resistance to the development of cardiac dysfunction in individuals with type 2 diabetes has remained unclear. Here we investigated the relation between left ventricular (LV) function as assessed by echocardiography and insulin resistance as evaluated by hyperinsulinemic-euglycemic clamp analysis, the gold standard for measurement of this parameter, in individuals with type 2 diabetes. METHODS This retrospective study included 34 individuals with type 2 diabetes who underwent both hyperinsulinemic-euglycemic clamp analysis and echocardiography. Both the insulin sensitivity index (ISI) as determined by glucose clamp analysis as well as HOMA-IR were determined as measures of insulin resistance. The ratio of the peak early- to late-diastolic mitral inflow velocities (E/A) and the LV ejection fraction (LVEF) were determined as measures of diastolic and systolic function, respectively. RESULTS The ISI was significantly correlated with both the E/A ratio and LVEF (correlation coefficients of 0.480 and 0.360, respectively), whereas HOMA-IR was not correlated with either cardiac parameter. Multivariate analysis revealed that ISI was an independent predictor for both a high log [E/A] (P = 0.031) and a high LVEF (P = 0.045). CONCLUSIONS Insulin resistance as evaluated by hyperinsulinemic-euglycemic clamp analysis may be causally related to LV diastolic and systolic dysfunction in individuals with type 2 diabetes.
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Affiliation(s)
- Natsu Otowa‐Suematsu
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Kazuhiko Sakaguchi
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
- Division of General Internal MedicineDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Akihiro Kaneko
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Jun Ito
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Yasuko Morita
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Hiroshi Miura
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Tomoko Yamada
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Anna So
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Hisako Komada
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Yuko Okada
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Yushi Hirota
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Yoshikazu Tamori
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
- Division of Creative Health PromotionDepartment of Social/Community Medicine and Health ScienceKobe University Graduate School of MedicineKobeJapan
| | - Wataru Ogawa
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
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Yan A, Xie G, Ding X, Wang Y, Guo L. Effects of Lipid Overload on Heart in Metabolic Diseases. Horm Metab Res 2021; 53:771-778. [PMID: 34891207 PMCID: PMC8664556 DOI: 10.1055/a-1693-8356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Metabolic diseases are often associated with lipid and glucose metabolism abnormalities, which increase the risk of cardiovascular disease. Diabetic cardiomyopathy (DCM) is an important development of metabolic diseases and a major cause of death. Lipids are the main fuel for energy metabolism in the heart. The increase of circulating lipids affects the uptake and utilization of fatty acids and glucose in the heart, and also affects mitochondrial function. In this paper, the mechanism of lipid overload in metabolic diseases leading to cardiac energy metabolism disorder is discussed.
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Affiliation(s)
- An Yan
- Tianjin University of Traditional Chinese Medicine, Tianjin,
China
| | - Guinan Xie
- Tianjin University of Traditional Chinese Medicine, Tianjin,
China
| | - Xinya Ding
- Tianjin University of Traditional Chinese Medicine, Tianjin,
China
| | - Yi Wang
- Tianjin University of Traditional Chinese Medicine, Tianjin,
China
- Correspondence Yi Wang Institute of Traditional Chinese MedicineTianjin University of Traditional Chinese Medicine300193 TianjinChina+86-22-59596555
| | - Liping Guo
- Tianjin Academy of Traditional Chinese Medicine, Tianjin,
China
- Liping Guo Tianjin Academy of Traditional Chinese Medicine300120 TianjinChina
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Kianu Phanzu B, Nkodila Natuhoyila A, Nzundu Tufuankenda A, Kokusa Zamani R, Limbole Baliko E, Kintoki Vita E, M’buyamba Kabangu JR, Longo-Mbenza B. Insulin resistance-related differences in the relationship between left ventricular hypertrophy and cardiorespiratory fitness in hypertensive Black sub-Saharan Africans. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:587-600. [PMID: 34849290 PMCID: PMC8611263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is associated with impaired cardiorespiratory fitness (CRF), a surrogate marker of poor outcome. Insulin resistance (IR) plays a central role in all stages of cardiovascular disease continuum. This study evaluates IR-related differences in the relationship between left ventricular mass (LVM) and CRF in asymptomatic newly diagnosed hypertensive Black sub-Saharan Africans. METHODS In this cross-sectional observational study, 126 asymptomatic newly diagnosed hypertensive participants (50.5 ± 9.5 years) underwent comprehensive resting transthoracic echocardiographic examination and maximal incremental cardiopulmonary exercise test (CPET). CRF was estimated in maximal oxygen uptake (VO2max). CPET results were compared between participants with and without LVH. Multivariate analysis examined the influence of IR on the observed differences. RESULTS Those with LVH had lower VO2max (15.7 ± 5.5 mL min-1 kg-1 vs. 18.4 ± 3.7 mL min-1 kg-1; P = 0.001) than those without LVH. In patients with IR, LVM (r = -0.261, P = 0.012), LVM indexed to body surface area (LVMIbsa; r = -0.229, P = 0.027), and LVM indexed to height to an allometric power of 2.7 (LVMIh2.7; r = -0.351, P = 0.001), and VO2max were negatively correlated. In hypertensive patients without IR, these same parameters and VO2max have no significant correlation. Body mass index (BMI), LVM, and LVMIbsa emerged as independent determinants of VO2max, explaining 46.9% of its variability (overall P = 0.001) in IR participants, a relationship not found in participants without IR. CONCLUSIONS IR may participate in the deterioration of CRF associated with LVH. Measures to improve insulin sensitivity should be considered for improving CRF and therefore the prognosis of insulin-resistant hypertensive patients. Targeting IR in hypertensive patients with LVH could improve prognosis.
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Affiliation(s)
- Bernard Kianu Phanzu
- Unit of Cardiology, University Hospital of KinshasaKinshasa, Democratic Republic of Congo
- Centre Médical de Kinshasa (CMK)Kinshasa, Democratic Republic of Congo
| | | | | | - Roger Kokusa Zamani
- Provincial Reference Hospital of KinshasaKinshasa, Democratic Republic of Congo
| | | | - Eleuthère Kintoki Vita
- Unit of Cardiology, University Hospital of KinshasaKinshasa, Democratic Republic of Congo
| | | | - Benjamin Longo-Mbenza
- Unit of Cardiology, University Hospital of KinshasaKinshasa, Democratic Republic of Congo
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Horodinschi RN, Diaconu CC. Diastolic function in patients with heart failure with preserved ejection fraction and atrial fibrillation: impact of diabetes. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:564-575. [PMID: 34849288 PMCID: PMC8611268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The objective of our study was to evaluate the severity of diastolic dysfunction in patients with heart failure with preserved ejection fraction (HFpEF), atrial fibrillation (AF) and type 2 diabetes mellitus (T2DM) compared to those with HFpEF and AF without DM. MATERIAL AND METHODS This is an observational, prospective, case-control study. We selected 720 patients with heart failure consecutively admitted between March 2019-December 2020, of whom 253 patients with AF. After applying the inclusion/exclusion criteria, 105 subjects remained in the study. The patients were divided into two groups, according to the presence of T2DM: group A (39 patients with T2DM, 37.14%), group B (66 patients without T2DM, 62.85%). 2D transthoracic echocardiography was performed in all patients. The study was approved by the Ethics Committee of the hospital. Statistical analysis was performed using R software, version 4.0.2. RESULTS Patients with HFpEF, AF, and T2DM had higher LV filling pressures compared to those without DM (OR = 5.00, 95% CI: 1.77-15.19). Moreover, patients with insulin-requiring T2DM (OR = 6.25, 95% CI: 1.50-25.98) had higher LV filling pressures than those treated with oral antidiabetic drugs (OR = 4.44, 95% CI: 1.37-15.17). We demonstrated that patients with T2DM had higher E/e' ratio (difference -2.78, P 0.0003, 95% CI: -4.24 to -1.31) and lower deceleration time (DT) (difference 23.04, P 0.0002, 95% CI: 11.10-34.97) than those without T2DM. CONCLUSIONS Patients with HFpEF, AF and T2DM have higher LV filling pressures than those without T2DM, suggesting that the presence of T2DM leads to a more severe diastolic dysfunction.
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Affiliation(s)
- Ruxandra-Nicoleta Horodinschi
- Department of Internal Medicine, University of Medicine and Pharmacy “Carol Davila”Bucharest, Romania
- Internal Medicine Clinic, Clinical Emergency Hospital of BucharestBucharest, Romania
| | - Camelia Cristina Diaconu
- Department of Internal Medicine, University of Medicine and Pharmacy “Carol Davila”Bucharest, Romania
- Internal Medicine Clinic, Clinical Emergency Hospital of BucharestBucharest, Romania
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Detection of early ultrasonographic markers of cardiovascular dysfunction in prediabetes patients: Cardiovascular markers in prediabetes. Ann Vasc Surg 2021; 82:339-346. [PMID: 34656709 DOI: 10.1016/j.avsg.2021.07.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prediabetes individuals may present incipient signals of cardiovascular injury and evaluate with unfavorable outcome. The aim of this study was to identify early ultrasonographic markers of cardiac dysfunction and arterial stiffness among glucose intolerant patients compared to healthy individuals. METHODS Cross-sectional study with the composition of two groups: Prediabetes (PD) who met the criteria for pre-diabetes and Normoglycemic (NG): presented no criteria of pre-diabetes and diabetes mellitus in all applied tests. Clinical evaluation, assessment of cardiac function by transthoracic echocardiogram, carotid intima-media thickness by carotid ultrasonographic and evaluation of arterial stiffness by SphygmoCor®ฏ device were performed. RESULTS Eighty adults were included in this study: PD (n=43) and NG (n=37). PD patients were more dyslipidemic and presented early alterations in echocardiographic variables, like: peak mitral velocity E (E (cm/s): NG 84±13 vs PD 77±11, p = 0.03), E/A Tricuspid inflow (NG: 1.5±0.4 vs PD 1.3±0.3, p=0.03), Tricuspid tissue Doppler E' (E'tric (cm/s): NG 15.2±4.4 vs PD 13.4±3.2, p=0.04) and increased arterial stiffness (Pulse Wave Velocity: PWV (m/s): NG 7.2±1.5 vs PD 7.9±1.7, p = 0.03). In the regression analysis, having an impaired oral glucose test was shown to be independently associated with reduced E Mitral, even after adjusting for a set of confounding factors. CONCLUSION PD patients showed early signals of an impaired cardiac function and an increased pulse wave velocity when compared with healthy individuals. These results point to treatment optimization strategies, especially when considering preventive measures for cardiovascular outcomes, like diabetic cardiomyopathy.
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Bojer AS, Sørensen MH, Bjerre J, Gaede P, Vejlstrup N, Madsen PL. Metabolic improvement with short-term, glucagon-like peptide-1 receptor agonist treatment does not improve cardiac diastolic dysfunction in patients with type 2 diabetes: A randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab 2021; 23:2374-2384. [PMID: 34189832 DOI: 10.1111/dom.14480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/14/2021] [Accepted: 06/27/2021] [Indexed: 01/16/2023]
Abstract
AIM To investigate if short-term treatment with liraglutide, a glucagon-like peptide-1 receptor agonist, improves left ventricular diastolic function. MATERIALS AND METHODS An investigator-initiated, double-blind, randomized, placebo-controlled trial on the effect of 18 weeks of treatment with liraglutide on diastolic function was assessed in patients with type 2 diabetes with signs of diastolic dysfunction (echo-Doppler determined E/e' ≥ 9 and/or lateral e' ≤ 10 cm/s). Primary outcomes were improved left ventricle filling (the early peak filling rate [ePFR]) and left atrium ease of emptying (the passive emptying fraction [LAPEF ]), assessed by cardiac magnetic resonance imaging at rest and during chronotropic stress. Secondary outcomes included left ventricular and left atrial volumes and systolic function, measures of aortic stiffness and echocardiographic diastolic variables. RESULTS Forty patients were randomized to liraglutide subcutaneously 1.8 mg/day (n = 20) or placebo (n = 20). Liraglutide reduced HbA1c (-0.47%, 95% CI [-0.88% to -0.06%] [-5.1, 95% CI {-9.7 to -0.62} mmol/mol]) and weight (-2.9, 95% CI [-4.6 to -1.2] kg); both P < .03. Liraglutide did not change ePFR at rest (-24 ± 60 vs. -6 ± 46 mL/s), during stress (2 ± 58 vs. -2 ± 38 mL/s), or the changes from rest to stress (12.9 ± 72.5 vs. 4.7 ± 104.0; all P > .05). LAPEF decreased with liraglutide during stress (-3.1% [-9.0%, 1.1%] vs. 1.0% [-2.9%, 6.1%]; P = .049), but no changes were evident at rest (-4.3% [-7.9%, 1.9%] vs. -0.6% [-3.1%, 2.2%]; P = .19), or for the changes from rest to stress (-1.7 ± 8.4 vs. 0.8 ± 8.2; P = .4). Secondary outcomes were unchanged by liraglutide. CONCLUSIONS Short-term treatment with liraglutide did not improve left ventricular diastolic function, suggesting the cardioprotective effect is not exerted through the improvement in diastolic dysfunction.
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Affiliation(s)
- Annemie Stege Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Martin Heyn Sørensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Jenny Bjerre
- Department of Cardiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Peter Gaede
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Kim GH, Park YJ. Accelerated diastolic dysfunction in premenopausal women with rheumatoid arthritis. Arthritis Res Ther 2021; 23:247. [PMID: 34560895 PMCID: PMC8461933 DOI: 10.1186/s13075-021-02629-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/12/2021] [Indexed: 12/18/2022] Open
Abstract
Background Disturbances of diastolic function precede systolic heart failure and, although clinically silent, represent the earliest sign of cardiac involvement. Diastolic dysfunction (DD) is associated with age, gender (female), and hypertension. However, little is known about the age-specific incidence rates and risk factors for DD in patients with rheumatoid arthritis (RA). Methods We used standard two-dimensional/Doppler echocardiography to screen for the presence of diastolic dysfunction in 61 patients with RA and 107 healthy subjects. All participants were premenopausal women with no history of hypertension. DD includes an impaired relaxation with or without increased left ventricular (LV) filling pressures, pseudonormal filling, and restrictive filling based on parameters measured using echocardiography. Results The two groups were similar with respect to age (P=0.269). Patients with RA had significantly higher LV mass index, LV filling pressure, and lower E/A velocity than controls. All patients had preserved ejection fraction (EF ≥50%). DD was more common in patients with RA at 47% compared to 26% in the controls (P=0.004). Women with RA in the 30- to 49-year age range were over 3.5 times more likely to have DD than those of similar age in the control group (OR=3.54; 95% CI 1.27 to 9.85). Among patients with RA, high CRP levels were independently associated with DD even after adjustment for cardiovascular risk factors (P=0.009). Conclusions In premenopausal women with RA, DD is much more common and the age of onset is reduced. Early screening of myocardial function may provide an opportunity for preventing future cardiovascular disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02629-1.
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Affiliation(s)
- Gee Hee Kim
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yune-Jung Park
- Division of Rheumatology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
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Sørensen MH, Bojer AS, Broadbent DA, Plein S, Madsen PL, Gæde P. Cardiac perfusion, structure, and function in type 2 diabetes mellitus with and without diabetic complications. Eur Heart J Cardiovasc Imaging 2021; 21:887-895. [PMID: 31642902 DOI: 10.1093/ehjci/jez266] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/08/2019] [Accepted: 10/12/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Coronary microvascular disease (CMD) is a known complication in type 2 diabetes mellitus (T2DM). We examined the relationship between diabetic complications, left ventricular (LV) function and structure and myocardial perfusion reserve (MPR) as indicators of CMD in patients with T2DM and control subjects. METHODS AND RESULTS This was a cross-sectional study of 193 patients with T2DM and 25 controls subjects. Patients were grouped as uncomplicated diabetes (n = 71) and diabetes with complications (albuminuria, retinopathy, and autonomic neuropathy). LV structure, function, adenosine stress, and rest myocardial perfusion were evaluated by cardiovascular magnetic resonance. Echocardiography was used to evaluate diastolic function. Patients with uncomplicated T2DM did not have significantly different LV mass and E/e* but decreased MPR (3.8 ± 1.0 vs. 5.1 ± 1.5, P < 0.05) compared with controls. T2DM patients with albuminuria and retinopathy had decreased MPR (albuminuria: 2.4 ± 0.9 and retinopathy 2.6 ± 0.7 vs. 3.8 ± 1.0, P < 0.05 for both) compared with uncomplicated T2DM patients, along with significantly higher LV mass (149 ± 39 and 147 ± 40 vs. 126 ± 33 g, P < 0.05) and E/e* (8.3 ± 2.8 and 8.1 ± 2.2 vs. 7.0 ± 2.5, P < 0.05). When entered in a multiple regression model, reduced MPR was associated with increasing E/e* and albuminuria and retinopathy were associated with reduced MPR. CONCLUSIONS Patients with uncomplicated T2DM have reduced MPR compared with control subjects, despite equivalent LV mass and E/e*. T2DM patients with albuminuria or retinopathy have reduced MPR and increased LV mass and E/e* compared with patients with uncomplicated T2DM. E/e* and MPR are significantly associated after adjustment for age, hypertension, and LV mass, suggesting a link between CMD and cardiac diastolic function. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.org. Unique identifier: NCT02684331.
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Affiliation(s)
- Martin Heyn Sørensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200 Slagelse, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Annemie Stege Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200 Slagelse, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - David Andrew Broadbent
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Great George St, LS1 3EX, Leeds, UK.,Biomedical Imaging Science Department, University of Leeds, LS2 9JT, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, Leeds, UK
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Capital Region of Denmark, Borgmester Ib Juels Vej 1, 2730 Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Peter Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200 Slagelse, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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Hegyi B, Fasoli A, Ko CY, Van BW, Alim CC, Shen EY, Ciccozzi MM, Tapa S, Ripplinger CM, Erickson JR, Bossuyt J, Bers DM. CaMKII Serine 280 O-GlcNAcylation Links Diabetic Hyperglycemia to Proarrhythmia. Circ Res 2021; 129:98-113. [PMID: 33926209 PMCID: PMC8221539 DOI: 10.1161/circresaha.120.318402] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 12/16/2022]
Abstract
[Figure: see text].
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MESH Headings
- Action Potentials
- Adult
- Aged
- Animals
- Arrhythmias, Cardiac/enzymology
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/physiopathology
- Biomarkers/blood
- Blood Glucose/metabolism
- Calcium Signaling
- Calcium-Calmodulin-Dependent Protein Kinase Type 2/genetics
- Calcium-Calmodulin-Dependent Protein Kinase Type 2/metabolism
- Case-Control Studies
- Diabetes Mellitus, Experimental/blood
- Diabetes Mellitus, Experimental/enzymology
- Diabetes Mellitus, Experimental/genetics
- Excitation Contraction Coupling
- Female
- Glycosylation
- Heart Rate
- Humans
- Male
- Mice, Inbred C57BL
- Mice, Inbred ICR
- Mice, Transgenic
- Middle Aged
- Mutation
- Myocardial Contraction
- Myocytes, Cardiac/enzymology
- NADPH Oxidase 2/genetics
- NADPH Oxidase 2/metabolism
- Phosphorylation
- Protein Processing, Post-Translational
- Mice
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Affiliation(s)
- Bence Hegyi
- Department of Pharmacology, University of California, Davis (B.H., A.F., C.Y.K., B.W.V., C.C.A., E.Y.S., M.M.C., S.T., C.M.R., J.B., D.M.B.)
| | - Anna Fasoli
- Department of Pharmacology, University of California, Davis (B.H., A.F., C.Y.K., B.W.V., C.C.A., E.Y.S., M.M.C., S.T., C.M.R., J.B., D.M.B.)
| | - Christopher Y. Ko
- Department of Pharmacology, University of California, Davis (B.H., A.F., C.Y.K., B.W.V., C.C.A., E.Y.S., M.M.C., S.T., C.M.R., J.B., D.M.B.)
| | - Benjamin W. Van
- Department of Pharmacology, University of California, Davis (B.H., A.F., C.Y.K., B.W.V., C.C.A., E.Y.S., M.M.C., S.T., C.M.R., J.B., D.M.B.)
| | - Chidera C. Alim
- Department of Pharmacology, University of California, Davis (B.H., A.F., C.Y.K., B.W.V., C.C.A., E.Y.S., M.M.C., S.T., C.M.R., J.B., D.M.B.)
| | - Erin Y. Shen
- Department of Pharmacology, University of California, Davis (B.H., A.F., C.Y.K., B.W.V., C.C.A., E.Y.S., M.M.C., S.T., C.M.R., J.B., D.M.B.)
| | - Marisa M. Ciccozzi
- Department of Pharmacology, University of California, Davis (B.H., A.F., C.Y.K., B.W.V., C.C.A., E.Y.S., M.M.C., S.T., C.M.R., J.B., D.M.B.)
| | - Srinivas Tapa
- Department of Pharmacology, University of California, Davis (B.H., A.F., C.Y.K., B.W.V., C.C.A., E.Y.S., M.M.C., S.T., C.M.R., J.B., D.M.B.)
| | - Crystal M. Ripplinger
- Department of Pharmacology, University of California, Davis (B.H., A.F., C.Y.K., B.W.V., C.C.A., E.Y.S., M.M.C., S.T., C.M.R., J.B., D.M.B.)
| | - Jeffrey R. Erickson
- Department of Physiology and HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand (J.R.E.)
| | - Julie Bossuyt
- Department of Pharmacology, University of California, Davis (B.H., A.F., C.Y.K., B.W.V., C.C.A., E.Y.S., M.M.C., S.T., C.M.R., J.B., D.M.B.)
| | - Donald M. Bers
- Department of Pharmacology, University of California, Davis (B.H., A.F., C.Y.K., B.W.V., C.C.A., E.Y.S., M.M.C., S.T., C.M.R., J.B., D.M.B.)
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Pugliese NR, DE Biase N, Balletti A, Filidei F, Pieroni A, D'Angelo G, Armenia S, Mazzola M, Gargani L, Del Punta L, Asomov M, Cerri E, Franzoni F, Nesti L, Mengozzi A, Paneni F, Masi S. Characterisation of haemodynamic and metabolic abnormalities in the heart failure spectrum: the role of combined cardiopulmonary and exercise echocardiography stress test. Minerva Cardiol Angiol 2021; 70:370-384. [PMID: 34137244 DOI: 10.23736/s2724-5683.21.05743-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heart failure (HF) is a complex clinical syndrome characterised by different etiologies and a broad spectrum of cardiac structural and functional abnormalities. Current guidelines suggest a classification based on left ventricular ejection fraction (LVEF), distinguishing HF with reduced (HFrEF) from preserved (HFpEF) LVEF. HF should also be thought of as a continuous range of conditions, from asymptomatic stages to clinically manifest syndrome. The transition from one stage to the next is associated with a worse prognosis. While the rate of HF-related hospitalisation is similar in HFrEF and HFpEF once clinical manifestations occur, accurate knowledge of the steps and risk factors leading to HF progression is still lacking, especially in HFpEF. Precise hemodynamic and metabolic characterisation of patients with or at risk of HF may help identify different disease trajectories and risk factors, with the potential to identify specific treatment targets that might offset the slippery slope towards overt clinical manifestations. Exercise can unravel early metabolic and haemodynamic alterations that might be silent at rest, potentially leading to improved risk stratification and more effective treatment strategies. Cardiopulmonary exercise testing (CPET) offers valuable aid to investigate functional alterations in subjects with or at risk of HF, while echocardiography can assess cardiac structure and function objectively, both at rest and during exercise (exercise stress echocardiography, ESE). The purpose of this narrative review is to summarise the potential advantages of using an integrated CPET-ESE evaluation in the characterisation of both subjects at risk of developing HF and patients with stable HF.
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Affiliation(s)
- Nicola R Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy -
| | - Nicolò DE Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessio Balletti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Filidei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandra Pieroni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Silvia Armenia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matteo Mazzola
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Institute of Clinical Physiology, C.N.R., Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, C.N.R., Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Muzaffar Asomov
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eugenio Cerri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ferdinando Franzoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Nesti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Zürich, Switzerland
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Lee M, Kim KJ, Chung TH, Bae J, Lee YH, Lee BW, Cha BS, Yun M, Kang ES. Nonalcoholic fatty liver disease, diastolic dysfunction, and impaired myocardial glucose uptake in patients with type 2 diabetes. Diabetes Obes Metab 2021; 23:1041-1051. [PMID: 33394549 DOI: 10.1111/dom.14310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
AIMS To investigate whether degree of nonalcoholic fatty liver disease (NAFLD) is associated with myocardial dysfunction related to impaired myocardial glucose uptake in patients with type 2 diabetes. MATERIALS AND METHODS In total, 131 patients with type 2 diabetes from a tertiary care hospital were included in this study. Myocardial glucose uptake was assessed using [18 F]-fluorodeoxyglucose-positron emission tomography. Hepatic steatosis and fibrosis were determined using transient liver elastography. Echocardiography was performed to evaluate cardiac structure and function. RESULTS Patients with NAFLD had cardiac diastolic dysfunction with higher left ventricular filling pressure (E/e' ratio) and left atrial (LA) volume index than patients without NAFLD (all P < 0.05). Hepatic steatosis correlated with E/e' ratio and LA volume index, and hepatic fibrosis also correlated with E/e' ratio (all P < 0.05). Even after adjusting for confounding factors, a higher degree of hepatic steatosis (r2 = 0.409, P = 0.041) and a higher degree of fibrosis (r2 = 0.423, P = 0.009) were independent contributing factors to a higher E/e' ratio. Decreased myocardial glucose uptake was associated with a higher degree of steatosis (P for trend = 0.084) and fibrosis (P for trend = 0.012). At the same time, decreased myocardial glucose uptake was an independent contributing factor for a higher E/e' ratio (r2 = 0.409; P = 0.040). CONCLUSIONS Hepatic steatosis and fibrosis were significantly associated with diastolic heart dysfunction in patients with type 2 diabetes coupled with impaired myocardial glucose uptake.
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Affiliation(s)
- Minyoung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Joon Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Ha Chung
- Department of Health Promotion, Severance Check-up, Health Promotion Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jaehyun Bae
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung-Wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong-Soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
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Chiu TH, Tsai HJ, Chiou HYC, Wu PY, Huang JC, Chen SC. A high triglyceride-glucose index is associated with left ventricular dysfunction and atherosclerosis. Int J Med Sci 2021; 18:1051-1057. [PMID: 33456363 PMCID: PMC7807181 DOI: 10.7150/ijms.53920] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/18/2020] [Indexed: 12/30/2022] Open
Abstract
Background: The triglyceride-glucose (TyG) index has been reported to be a simple and reliable surrogate marker of insulin resistance. The aim of this study was to investigate associations between the TyG index and echocardiographic parameters including left ventricular mass (LVM), left atrial diameter (LAD) and left ventricular ejection fraction (LVEF), and markers of peripheral artery disease, ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV). Methods: A total of 823 (483 males and 340 females) patients were enrolled from 2007 to 2011 at a regional hospital in southern Taiwan. Multivariable stepwise linear regression analysis was performed to identify the factors related to echocardiographic parameters and peripheral artery disease. Results: The patients were stratified into four groups according to TyG index quartile. Multivariable stepwise linear regression analysis showed that a higher TyG index was associated with elevated observed/predicted LVM (p = 0.081), increased LAD (p = 0.004), decreased LVEF (p = 0.003) and lower ABI (p = 0.030), but not observed/predicted LVM and baPWV. Conclusions: A high TyG index was significantly associated with high LAD, low LVEF and low ABI. However, the TyG index was not significantly associated with inappropriate LVM or baPWV. The results suggest that the TyG index, as a simple indicator of insulin resistance, may reflect cardiac remodeling and dysfunction and atherosclerosis.
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Affiliation(s)
- Tai-Hua Chiu
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hui-Ju Tsai
- Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Ying Clair Chiou
- Teaching and Research Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Paiman EHM, de Mutsert R, Widya RL, Rosendaal FR, Jukema JW, Lamb HJ. The role of insulin resistance in the relation of visceral, abdominal subcutaneous and total body fat to cardiovascular function. Nutr Metab Cardiovasc Dis 2020; 30:2230-2241. [PMID: 32912791 DOI: 10.1016/j.numecd.2020.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS The separate cardiovascular effects of type 2 diabetes and adiposity remain to be examined. This study aimed to investigate the role of insulin resistance in the relations of visceral (VAT), abdominal subcutaneous (aSAT) adipose tissue and total body fat (TBF) to cardiovascular remodeling. METHODS AND RESULTS In this cross-sectional analysis of the population-based Netherlands Epidemiology of Obesity study, 914 middle-aged individuals (46% men) were included. Participants underwent magnetic resonance imaging. Standardized linear regression coefficients (95%CI) were calculated, adjusted for potential confounding factors. All fat depots and insulin resistance (HOMA-IR), separate from VAT and TBF, were associated with lower mitral early and late peak filling rate ratios (E/A): -0.04 (-0.09;0.01) per SD (54 cm2) VAT; -0.05 (-0.10;0.00) per SD (94 cm2) aSAT; -0.09 (-0.16;-0.02) per SD (8%) TBF; -0.11 (-0.17;-0.05) per 10-fold increase in HOMA-IR, whereas VAT and TBF were differently associated with left ventricular (LV) end-diastolic volume: -8.9 (-11.7;-6.1) mL per SD VAT; +5.4 (1.1;9.7) mL per SD TBF. After adding HOMA-IR to the model to evaluate the mediating role of insulin resistance, change in E/A was -0.02 (-0.07;0.04) per SD VAT; -0.03 (-0.08;0.02) per SD aSAT; -0.06 (-0.13;0.01) per SD TBF, and change in LV end-diastolic volume was -7.0 (-9.7;-4.3) mL per SD VAT. In women, adiposity but not HOMA-IR was related to higher aortic arch pulse wave velocity. CONCLUSION Insulin resistance was associated with reduced diastolic function, separately from VAT and TBF, and partly mediated the associations between adiposity depots and lower diastolic function.
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Affiliation(s)
- Elisabeth H M Paiman
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ralph L Widya
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Sørensen MH, Bojer AS, Jørgensen NR, Broadbent DA, Plein S, Madsen PL, Gæde P. Fibroblast growth factor-23 is associated with imaging markers of diabetic cardiomyopathy and anti-diabetic therapeutics. Cardiovasc Diabetol 2020; 19:158. [PMID: 32998751 PMCID: PMC7528463 DOI: 10.1186/s12933-020-01135-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background The biomarker fibroblast growth factor-23 (FGF-23) has been associated with increased cardiovascular morbidity and mortality in both patients with and without type 2 diabetes. The aim of this study was to evaluate the relationship between FGF-23 and cardiac structure, function and perfusion in patients with type 2 diabetes and normal or mildly impaired kidney function. Furthermore, to investigate the association between FGF-23, anti-diabetes therapy and the classic complications and risk factors associated with type 2 diabetes. Methods In this cross-sectional study, 246 patients with type 2 diabetes underwent echocardiography and advanced cardiac magnetic resonance imaging to assess left ventricular (LV) structure and function. In addition, myocardial blood flow (MBF) during rest and pharmacological stress (adenosine 140 µg/kg/min) were evaluated in 183 of the patients. Patients with eGFR < 60 ml/min/1.73 m2 were excluded. Results Median (Q1–Q3) FGF-23 was 74 (58–91) ng/L. Patients with FGF-23 above the median had lower MBF during stress (2.3 ± 0.9 vs. 2.7 ± 0.9 ml/min/g, P = 0.001) and lower overall myocardial perfusion reserve (MPR) (2.7 ± 0.8 vs. 3.3 ± 1.1, P < 0.001). LV mass (143 ± 40 vs. 138 ± 36 g, P = 0.04) and E/e* (8.5 ± 3.2 vs. 7.6 ± 2.7, P = 0.04) were higher in patients with FGF-23 above the median. In a linear model adjusted for age, sex, eGFR and hypertension, increasing FGF-23 was associated with decreased MPR (P < 0.01, R2 = 0.11) and increased E/e* (P < 0.01, R2 = 0.07). FGF-23 was lower in patients receiving glucagon like peptide-1 (GLP-1) analogues (71 (57–86) vs. 80 (60–98) ng/L, P = 0.01) than in those who did not receive GLP-1 analogues. Conclusions In patients with type 2 diabetes and normal or mildly impaired kidney function, increased levels of FGF-23 are associated with impaired cardiac diastolic function and decreased MPR, caused by a decrease in maximal MBF during stress. Use of GLP-1 analogues is associated with decreased levels of FGF-23. Clinical trial registrationhttps://www.clinicaltrials.gov. Unique identifier: NCT02684331. Date of registration: February 18, 2016
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Affiliation(s)
- Martin H Sørensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200, Slagelse, Region Zealand, Denmark. .,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Annemie S Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200, Slagelse, Region Zealand, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niklas R Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Capital Region of Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - David A Broadbent
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Per L Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Capital Region of Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200, Slagelse, Region Zealand, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Packer M, Lam CS, Lund LH, Maurer MS, Borlaug BA. Characterization of the inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction: a hypothesis to explain influence of sex on the evolution and potential treatment of the disease. Eur J Heart Fail 2020; 22:1551-1567. [PMID: 32441863 PMCID: PMC7687188 DOI: 10.1002/ejhf.1902] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 12/11/2022] Open
Abstract
Accumulating evidence points to the existence of an inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction (HFpEF), which is characterized by biomarkers of inflammation, an expanded epicardial adipose tissue mass, microvascular endothelial dysfunction, normal-to-mildly increased left ventricular volumes and systolic blood pressures, and possibly, altered activity of adipocyte-associated inflammatory mediators. A broad range of adipogenic metabolic and systemic inflammatory disorders - e.g. obesity, diabetes and metabolic syndrome as well as rheumatoid arthritis and psoriasis - can cause this phenotype, independent of the presence of large vessel coronary artery disease. Interestingly, when compared with men, women are both at greater risk of and may suffer greater cardiac consequences from these systemic inflammatory and metabolic disorders. Women show disproportionate increases in left ventricular filling pressures following increases in central blood volume and have greater arterial stiffness than men. Additionally, they are particularly predisposed to epicardial and intramyocardial fat expansion and imbalances in adipocyte-associated proinflammatory mediators. The hormonal interrelationships seen in inflammatory-metabolic phenotype may explain why mineralocorticoid receptor antagonists and neprilysin inhibitors may be more effective in women than in men with HFpEF. Recognition of the inflammatory-metabolic phenotype may improve an understanding of the pathogenesis of HFpEF and enhance the ability to design clinical trials of interventions in this heterogeneous syndrome.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular InstituteBaylor University Medical CenterDallasTXUSA
- Imperial College LondonLondonUK
| | - Carolyn S.P. Lam
- National Heart Centre Singapore and Duke‐National University of SingaporeSingapore
- University Medical Centre GroningenGroningenThe Netherlands
- The George Institute for Global HealthSydneyAustralia
| | - Lars H. Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
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Tan Y, Zhang Z, Zheng C, Wintergerst KA, Keller BB, Cai L. Mechanisms of diabetic cardiomyopathy and potential therapeutic strategies: preclinical and clinical evidence. Nat Rev Cardiol 2020; 17:585-607. [PMID: 32080423 PMCID: PMC7849055 DOI: 10.1038/s41569-020-0339-2] [Citation(s) in RCA: 351] [Impact Index Per Article: 87.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 02/07/2023]
Abstract
The pathogenesis and clinical features of diabetic cardiomyopathy have been well-studied in the past decade, but effective approaches to prevent and treat this disease are limited. Diabetic cardiomyopathy occurs as a result of the dysregulated glucose and lipid metabolism associated with diabetes mellitus, which leads to increased oxidative stress and the activation of multiple inflammatory pathways that mediate cellular and extracellular injury, pathological cardiac remodelling, and diastolic and systolic dysfunction. Preclinical studies in animal models of diabetes have identified multiple intracellular pathways involved in the pathogenesis of diabetic cardiomyopathy and potential cardioprotective strategies to prevent and treat the disease, including antifibrotic agents, anti-inflammatory agents and antioxidants. Some of these interventions have been tested in clinical trials and have shown favourable initial results. In this Review, we discuss the mechanisms underlying the development of diabetic cardiomyopathy and heart failure in type 1 and type 2 diabetes mellitus, and we summarize the evidence from preclinical and clinical studies that might provide guidance for the development of targeted strategies. We also highlight some of the novel pharmacological therapeutic strategies for the treatment and prevention of diabetic cardiomyopathy.
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Affiliation(s)
- Yi Tan
- Pediatric Research Institute, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.
- Wendy Novak Diabetes Center, University of Louisville, Norton Children's Hospital, Louisville, KY, USA.
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA.
| | - Zhiguo Zhang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Chao Zheng
- The Second Affiliated Hospital Center of Chinese-American Research Institute for Diabetic Complications, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kupper A Wintergerst
- Pediatric Research Institute, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
- Wendy Novak Diabetes Center, University of Louisville, Norton Children's Hospital, Louisville, KY, USA
- Division of Endocrinology, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Bradley B Keller
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA
- Kosair Charities Pediatric Heart Research Program, Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA
| | - Lu Cai
- Pediatric Research Institute, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.
- Wendy Novak Diabetes Center, University of Louisville, Norton Children's Hospital, Louisville, KY, USA.
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA.
- Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA.
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Alogaily MH, Alsaffar AJ, Hamid MB. Left ventricle diastolic dysfunction in a sample of prediabetic adults from Baghdad, Iraq. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00858-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Han BG, Lee JY, Kim MR, Shin H, Kim JS, Yang JW, Kim JY. Fluid overload is a determinant for cardiac structural and functional impairments in type 2 diabetes mellitus and chronic kidney disease stage 5 not undergoing dialysis. PLoS One 2020; 15:e0235640. [PMID: 32730268 PMCID: PMC7392282 DOI: 10.1371/journal.pone.0235640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/19/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Fluid overload is common in patients with diabetes and chronic kidney disease (DM and CKD; DMCKD) and can lead to structural and functional cardiac abnormalities including left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD). Fluid overload represents a crucial step in the pathophysiological pathways to chronic heart failure in patients with end-stage renal disease. We evaluated the impact of fluid overload on cardiac alterations in patients with diabetes and non-dialysis-dependent CKD stage 5 (DMCKD5-ND) without intrinsic heart disease. METHODS Bioimpedance spectroscopy, echocardiography, and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) measurement were performed in 135 consecutive patients on the same day. Patients were divided into groups by tertiles of overhydration/extracellular water (OH/ECW) per bioimpedance spectroscopy. RESULTS Fluid balance markers including OH/ECW and NT-proBNP were significantly higher in the LVDD+LVH group. OH/ECW and its exacerbation were positively associated with the ratio between early mitral inflow and annular early diastolic velocities (E/e' ratio) and left ventricular mass index (LVMI). The prevalence of LVH progressively increased across increasing tertiles of OH/ECW. In multiple regression analyses, OH/ECW as a continuous and categorical variable was independently associated with the E/e' ratio and LVMI after adjustment for multiple confounding factors. CONCLUSIONS Fluid overload was independently associated with LVDD and LVH in patients with DMCKD5-ND. Our study suggests that structural and functional cardiac abnormalities and volume status should be evaluated simultaneously in patients with early-stage DMCKD rather than only DMCKD5-ND, in addition to intensive blood pressure and glycemic control, regardless of evident cardiovascular disease.
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Affiliation(s)
- Byoung-Geun Han
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea
| | - Jun Young Lee
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea
| | - Mi Ryung Kim
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea
| | - Hanwul Shin
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea
| | - Jae-Seok Kim
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea
| | - Jae-Won Yang
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea
| | - Jong Yeon Kim
- Department of Neurosurgery, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea
- * E-mail:
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Schrub F, Oger E, Bidaut A, Hage C, Charton M, Daubert JC, Leclercq C, Linde C, Lund L, Donal E. Heart failure with preserved ejection fraction: A clustering approach to a heterogenous syndrome. Arch Cardiovasc Dis 2020; 113:381-390. [DOI: 10.1016/j.acvd.2020.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/14/2020] [Accepted: 03/05/2020] [Indexed: 12/23/2022]
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Rendón-Giraldo JA, Godoy-Palomino AL. Detección temprana de la falla cardiaca en pacientes diabéticos: Más allá de la fracción de eyección. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Sousa C. Assessment of diastolic function: How much more evidence do we need? Rev Port Cardiol 2020; 38:805-807. [PMID: 31982267 DOI: 10.1016/j.repc.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Carla Sousa
- Serviço de Cardiologia, Centro Hospitalar de S. João, EPE, Porto, Portugal.
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Zhao Z, Hou C, Ye X, Cheng J. Echocardiographic Changes in Newly Diagnosed Type 2 Diabetes Mellitus Patients with and without Hypertension. Med Sci Monit 2020; 26:e918972. [PMID: 31982890 PMCID: PMC7001517 DOI: 10.12659/msm.918972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Whether type 2 diabetes mellitus (T2DM) is independently associated with structural heart abnormalities is controversial because of confounders associated with T2DM. This study aimed to investigate echocardiographic features in patients with newly diagnosed T2DM, exploring changes in cardiac structure and function. Material/Methods This was a retrospective study of new T2DM cases treated at the Second People’s Hospital Affiliated to Nanjing Medical University (Changzhou) in 2014–2016. In all, 128 T2DM cases were included (62 hypertensive and 66 non-hypertensive individuals). Controls were selected among individuals who underwent examination at the same department/period. Interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDD), posterior left ventricular wall thickness (PWTD), left ventricle mass (LVM), end-diastolic thickness of left ventricular posterior wall (Dd), aortic root diameter, left atrial diameter (LAd), left atrial diameter fraction-shortening values, and left ventricular ejection fraction (LVEF) were determined routinely. Results IVST, LVEDD, PWTD, Dd, LAd, and left atrial diameter fraction-shortening values were larger in patients with T2DM (all P<0.05 vs. controls). LVM was higher in T2DM patients (median, 57.12 vs. 54.77 g, P=0.001). There were no differences in aortic root diameter and EF (both P>0.05). Multivariable analysis showed that IVST (OR=1.33, 95% CI: 1.01–1.76, P=0.04), LAd (OR=1.16, 95% CI: 1.07–1.25, P<0.001), TGs (OR=1.34, 95% CI: 1.09–1.63, P=0.005), and HDL (OR=1.46, 95% CI: 1.02–2.08, P=0.04) were independently associated with hypertension in patients with T2DM. Conclusions Patients with newly diagnosed T2DM already display structural heart abnormalities. LAd and IVST are independently associated with hypertension in these patients, probably contributing to increased cardiovascular risk.
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Affiliation(s)
- Zhen Zhao
- Department of Endocrinology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Can Hou
- Department of Cardiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Xinhua Ye
- Department of Endocrinology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Jinluo Cheng
- Department of Endocrinology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
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Alarco W. [Diabetes and Heart Failure]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2020; 1:6-14. [PMID: 38571972 PMCID: PMC10986355 DOI: 10.47487/apcyccv.v1i1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/24/2020] [Indexed: 04/05/2024]
Abstract
Diabetes Mellitus (DM) is a chronic non-communicable cardio-metabolic disease that causes macro-vascular complications such as atherosclerosis, coronary disease and heart failure (HF). There is a bidirectional relationship between HF and DM, HF being the second most frequent initial cardiovascular event in patients with diabetes. It may even be the first cardiovascular complication, before acute myocardial infarction. DM can lead to HF through mechanisms mediated by atherosclerosis and non mediated by it. In the first case, cholesterol is deposited in coronary arteries, favored by the presence of other risk factors. In the second case, the myocardium is directly affected leading to structural and functional changes through non-atherogenic mechanisms (called Diabetic Cardiomyopathy). The treatment of HF with reduced ejection fraction in the diabetic patient does not differ from that of the non-diabetic population, the triple neurohumoral block must be achieved. In the case of patients with HF with ejection fraction preserved to date, we do not have specific therapy to reduce cardiovascular morbidity and mortality. In the diabetes treatment of the patient with HF, sodium-glucose type 2 cotransporter inhibitors (SGLT2i) clearly stand out. In addition to their glucosuric and natriuretic effect, they have pleiotropic effects that produce metabolic, hemodynamic and cellular viability effects preventing apoptosis and cell death. Finally, the clinical benefits of SGLT2 inhibitors in HF go beyond glycemic control, as demonstrated by the DAPA-HF study; initiating a new era in the treatment of patients with HF with reduced ejection fraction.
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Affiliation(s)
- Walter Alarco
- Unidad de Insuficiencia Cardiaca, Trasplante Cardiaco e Hipertensión Pulmonar Instituto Nacional Cardiovascular INCOR. Lima, Perú.
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Santos-Ferreira D, Gonçalves-Teixeira P, Fontes-Carvalho R. SGLT-2 Inhibitors in Heart Failure and Type-2 Diabetes: Hitting Two Birds with One Stone? Cardiology 2019; 145:311-320. [DOI: 10.1159/000504694] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/11/2019] [Indexed: 11/19/2022]
Abstract
Type 2 diabetes mellitus (T2DM) and heart failure (HF) have a tremendous impact worldwide, markedly reducing life-expectancy and quality of life. It is now known that each disease represents a risk factor for the other. Moreover, when they are combined, the prognosis is significantly worse. Until recently, these pathologies have been managed independently. However, their treatment paradigm is rapidly changing, with recent cardiovascular outcome trials showing that sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are effective in the management of both diseases. This article explores the interactions between T2DM and HF and the concept of diabetic cardiomyopathy and summarizes recent data regarding the effects of SGLT-2i on HF hospitalization and the proposed pathophysiological mechanisms involved.
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Li S, Zheng Z, Tang X, Zhong J, Liu X, Zhao Y, Chen L, Zhu J, Liu J, Chen Y. Impact of HbA1c variability on subclinical left ventricular remodeling and dysfunction in patients with type 2 diabetes mellitus. Clin Chim Acta 2019; 502:159-166. [PMID: 31866332 DOI: 10.1016/j.cca.2019.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/25/2019] [Accepted: 12/06/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Glycemic instability confers a risk of poor prognosis in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate whether HbA1c variability provided additional value over mean HbA1c for predicting subclinical left ventricular remodeling and dysfunction in T2DM patients. METHODS A total of 466 T2DM patients with normal cardiac structure and function were recruited and prospectively followed up for a median of 4.7 y. HbA1c was measured quarterly. The intrapersonal mean and standard deviation (SD) of HbA1c measurements were calculated, and SD-HbA1c was considered as a measure of HbA1c variability. All participants underwent transthoracic echocardiography at baseline and after follow-up. RESULTS In multivariable regression analyses, SD-HbA1c was independently associated with annualized changes in left ventricular end diastolic diameter, interventricular septum, left ventricular posterior wall, left ventricular mass index, left ventricular ejection fraction, E/e' ratio, and E/A ratio (P < 0.001). Subgroup analysis based on mean HbA1c levels (<7.0%, 7.0-7.5%, and ≥7.5%) further confirmed that SD-HbA1c was associated with most of the above parameters regardless of mean HbA1c levels. CONCLUSION This study indicates that HbA1c variability adds to the mean value in predicting subclinical left ventricular remodeling and dysfunction in T2DM patients.
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Affiliation(s)
- Suhua Li
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Zhenda Zheng
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Xixiang Tang
- Department of Endocrinology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China; Advanced Medical Center, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Junlin Zhong
- Department of Ultrasonography, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Xing Liu
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Yunyue Zhao
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Lin Chen
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Jieming Zhu
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
| | - Jinlai Liu
- Department of Cardiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
| | - Yanming Chen
- Department of Endocrinology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
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