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Jex N, Chowdhary A, Thirunavukarasu S, Procter H, Sengupta A, Natarajan P, Kotha S, Poenar AM, Xue H, Cubbon R, Kellman P, Greenwood JP, Plein S, Page SP, Levelt E. Coexistent diabetes is associated with the presence of adverse phenotypic features in patients with hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Type 2 diabetes mellitus (DM) is associated with worsened clinical outcomes in hypertrophic cardiomyopathy (HCM) patients. The reasons for this adverse prognostic association are incompletely understood. Although distinct entities both HCM and DM share common features of impaired myocardial energetics and coronary microvascular function.
Purpose
We sought to test the hypothesis that co-existent diabetes is associated with greater reductions in myocardial energetics and perfusion, and higher scar burden in HCM.
Research design and methods
Seventy-five age- and sex-matched participants with concomitant HCM and DM (HCM-DM, n=20), isolated HCM (n=20), isolated DM (n=20) and healthy volunteers (HV, n=15) underwent 31phosphorus magnetic resonance spectroscopy and cardiovascular magnetic resonance imaging. The HCM groups were matched for HCM phenotype. The DM groups were matched for diabetes treatment, duration, HbA1c, body mass index and hypertension comorbidity.
Results
ESC sudden cardiac death risk scores were comparable between the HCM groups (HCM: 2.2±1.5%, HCM-DM: 1.9±1.2%; p=NS) and sarcomeric mutations were equally common. HCM-DM had the highest NT-proBNP levels (HV: 42 ng/L [IQR: 35–66], DM: 118 ng/L [IQR: 53–187], HCM: 298 ng/L [IQR: 157–837], HCM-DM: 726 ng/L [IQR: 213–8695]; p<0.0001). Left-ventricular ejection fraction, mass and wall thickness were similar between the HCM groups. HCM-DM displayed a greater degree of fibrosis burden with higher scar percentage, and lower global longitudinal strain compared to the isolated HCM. PCr/ATP was similarly decreased in the HCM-DM and DM (HV: 2.17±0.49, DM: 1.61±0.23, HCM: 1.93±0.38, HCM-DM: 1.54±0.27; p=0.0003). HCM-DM had the lowest stress myocardial blood flow (HV: 2.06±0.42 ml/min/g, DM: 1.78±0.45 ml/min/g, HCM: 1.74±0.44 ml/min/g, HCM-DM: 1.39±0.42 ml/min/g; p=0.004).
Conclusions
We show for the first time that HCM patients with DM comorbidity display greater reductions in myocardial energetics, perfusion, contractile function and higher myocardial scar burden and serum NT-proBNP levels compared to patients with isolated HCM despite similar LV mass and wall thickness and presence of sarcomeric mutations. These adverse phenotypic features may be important components of the adverse clinical manifestation attributable to a combined presence of HCM and DM.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Diabetes UK
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Affiliation(s)
- N Jex
- University of Leeds , Leeds , United Kingdom
| | - A Chowdhary
- University of Leeds , Leeds , United Kingdom
| | | | - H Procter
- Leeds General Infirmary, Cardiology , Leeds , United Kingdom
| | - A Sengupta
- Leeds General Infirmary, Cardiology , Leeds , United Kingdom
| | - P Natarajan
- University of Leeds , Leeds , United Kingdom
| | - S Kotha
- University of Leeds , Leeds , United Kingdom
| | - A M Poenar
- Leeds General Infirmary, Cardiology , Leeds , United Kingdom
| | - H Xue
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | - R Cubbon
- University of Leeds , Leeds , United Kingdom
| | - P Kellman
- National Heart Lung and Blood Institute , Bethesda , United States of America
| | | | - S Plein
- University of Leeds , Leeds , United Kingdom
| | - S P Page
- Leeds General Infirmary, Cardiology , Leeds , United Kingdom
| | - E Levelt
- University of Leeds , Leeds , United Kingdom
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Begg GA, Karim R, Oesterlein T, Graham L, Hogarth AJ, Page SP, Pepper CB, Rhode K, Lip GYH, Holden AV, Plein S, Tayebjee MH. 28Left atrial voltage predicts AF recurrence after ablation, irrespective of the rhythm during mapping, while circulating biomarkers of fibrosis do not. Europace 2017. [DOI: 10.1093/europace/eux283.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kirkby CM, Shunmugam SR, Man S, Page SP, Schilling RJ. 078 PATIENTS WITH ‘IDIOPATHIC’ VENTRICULAR FIBRILLATION AND AN ICD. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Herring N, Page SP, Ahmed M, Burg M, Hunter R, Earley MJ, Sporton SC, Bashir Y, Betts TR, Schilling R, Rajappan K. 052 The prevalence of left atrial appendage thrombus in patients undergoing catheter ablation for atrial fibrillation maintained on warfarin. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Page SP, Kounas S, Syrris P, Christiansen MI, Rune-Hansen F, Andersen PS, Elliott PM, McKenna WJ. 073 Evaluation of clinical markers of early disease expression and the ability to predict genotype in families with HCM and mutations in cardiac myosin binding protein C. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Page SP, Kounas S, Andersen PS, Frank-Hansen R, Elliott PM, Syrris P, Christiansen M, McKenna WJ. 069 Cardiac myosin binding protein C mutations in families with hypertrophic cardiomyopathy: disease expression in relation to age, gender, and long term outcome. Heart 2010. [DOI: 10.1136/hrt.2010.195966.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shah JS, Esteban MTT, Thaman R, Sharma R, Mist B, Pantazis A, Ward D, Kohli SK, Page SP, Demetrescu C, Sevdalis E, Keren A, Pellerin D, McKenna WJ, Elliott PM. Prevalence of exercise-induced left ventricular outflow tract obstruction in symptomatic patients with non-obstructive hypertrophic cardiomyopathy. Heart 2007; 94:1288-94. [DOI: 10.1136/hrt.2007.126003] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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