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El Hayek MS, Ernande L, Benitah JP, Gomez AM, Pereira L. The role of hyperglycaemia in the development of diabetic cardiomyopathy. Arch Cardiovasc Dis 2021; 114:748-760. [PMID: 34627704 DOI: 10.1016/j.acvd.2021.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 01/08/2023]
Abstract
Diabetes mellitus is a metabolic disorder with a chronic hyperglycaemic state. Cardiovascular diseases are the primary cause of mortality in patients with diabetes. Increasing evidence supports the existence of diabetic cardiomyopathy, a cardiac dysfunction with impaired cardiac contraction and relaxation, independent of coronary and/or valvular complications. Diabetic cardiomyopathy can lead to heart failure. Several preclinical and clinical studies have aimed to decipher the underlying mechanisms of diabetic cardiomyopathy. Among all the co-factors, hyperglycaemia seems to play an important role in this pathology. Hyperglycaemia has been shown to alter cardiac metabolism and function through several deleterious mechanisms, such as oxidative stress, inflammation, accumulation of advanced glycated end-products and upregulation of the hexosamine biosynthesis pathway. These mechanisms are responsible for the activation of hypertrophic pathways, epigenetic modifications, mitochondrial dysfunction, cell apoptosis, fibrosis and calcium mishandling, leading to cardiac stiffness, as well as contractile and relaxation dysfunction. This review aims to describe the hyperglycaemic-induced alterations that participate in diabetic cardiomyopathy, and their correlation with the severity of the disease and patient mortality, and to provide an overview of cardiac outcomes of glucose-lowering therapy.
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Affiliation(s)
| | - Laura Ernande
- INSERM U955, Université Paris-Est Créteil (UPEC), 94010 Créteil, France; Department of Cardiology, Institut Mondor de Recherche Biomédicale, INSERM U955-Équipe 8, Faculté de Médecine de Créteil, 94010 Créteil, France
| | | | - Ana-Maria Gomez
- Université Paris-Saclay, INSERM, UMR-S 1180, 92296 Châtenay-Malabry, France
| | - Laetitia Pereira
- Université Paris-Saclay, INSERM, UMR-S 1180, 92296 Châtenay-Malabry, France.
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Shahim B, Ben-Yehuda O, Chen S, Redfors B, Madhavan MV, Kar S, Lim DS, Asch FM, Weissman NJ, Cohen DJ, Arnold SV, Liu M, Lindenfeld J, Abraham WT, Mack MJ, Stone GW. Impact of Diabetes on Outcomes After Transcatheter Mitral Valve Repair in Heart Failure: COAPT Trial. JACC-HEART FAILURE 2021; 9:559-567. [PMID: 34325886 DOI: 10.1016/j.jchf.2021.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This paper sought to determine whether diabetes influences the outcomes of transcatheter mitral valve repair (TMVr) in patients with heart failure (HF) and secondary mitral regurgitation (SMR). BACKGROUND Diabetes is associated with worse outcomes in patients with HF. METHODS The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With functional Mitral Regurgitation) trial randomized HF patients with 3+ or 4+ SMR to MitraClip plus guideline-directed medical therapy (GDMT) versus GDMT alone. Two-year outcomes were evaluated in patients with versus without diabetes. RESULTS Of 614 patients, 229 (37.3%) had diabetes. Diabetic patients had higher 2-year rates of death than those without diabetes (40.8% vs 32.3%, respectively; adjusted P = 0.04) and tended to have higher rates of HF hospitalization (HFH) (HFH: 50.1% vs 43.0%, respectively; adjusted P = 0.07). TMVr reduced the 2-year rate of death consistently in patients with (30.3% vs 49.9%, respectively; adjusted HR: 0.51; 95% CI: 0.32 to 0.81) and without (27.0% vs 38.3%, respectively; adjusted HR: 0.57; 95% CI: 0.39-0.84) diabetes (Pinteraction = 0.72). TMVr also consistently reduced the 2-year rates of HFH in patients with (32.2% vs 54.8%, respectively; adjusted HR: 0.41; 95% CI: 0.28-0.58) and without (41.5% vs 59.0%, respectively; adjusted HR: 0.54: 95% CI 0.35-0.82) diabetes (Pinteraction = 0.33). Greater movements in quality-of-life (QOL) and exercise capacity occurred with TMVr than with GDMT alone, regardless of diabetic status. CONCLUSIONS Among HF patients with severe SMR in the COAPT trial, those with diabetes had a worse prognosis. Nonetheless, diabetic and nondiabetic patients had consistent reductions in the 2-year rates of death and HFH and improvements in QOL and functional capacity following TMVr treatment using the MitraClip than with maintenance on GDMT alone. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [COAPT]; NCT01626079).
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Affiliation(s)
- Bahira Shahim
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Division of Cardiology, University of California San Diego, San Diego, California, USA
| | - Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mahesh V Madhavan
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA; Bakersfield Heart Hospital, Bakersfield, California, USA
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Federico M Asch
- MedStar Health Research Institute, Washington, DC, USA; Georgetown University, Washington, DC, USA
| | - Neil J Weissman
- MedStar Health Research Institute, Washington, DC, USA; Georgetown University, Washington, DC, USA
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital, Roslyn, New York, USA
| | - Suzanne V Arnold
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA; Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Mengdan Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, the Ohio State University, Columbus, Ohio, USA
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Walpot J, Inácio JR, Massalha S, Hossain A, Small GR, Crean AM, Yam Y, Rybicki F, Dwivedi G, Chow BJW. Determining Early Remodeling Patterns in Diabetes and Hypertension Using Cardiac Computed Tomography: The Feasibility of Assessing Early LV Geometric Changes. Am J Hypertens 2020; 33:496-504. [PMID: 31903488 DOI: 10.1093/ajh/hpaa002] [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: 11/20/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is conflicting data on early left ventricle (LV) remodeling in diabetes mellitus (DM) and hypertension (HTN). This study examines the feasibility of cardiac computed tomography angiography (CCTA) to detect early LV geometric changes in patients with DM and HTN. METHODS Consecutive patients (n = 5,992) who underwent prospective electrocardiography (ECG)-triggered (mid-diastolic) CCTA were screened. Patients with known structural heart disease or known LV dysfunction were excluded. Left ventricular mass (LVM), left ventricular mid-diastolic volume (LVMDV), and LV concentricity (LVM/LVMDV) were measured and indexed to body surface area. RESULTS A total of 4,283 patients were analyzed (mean age 57 ± 10.69 years, female 46.7%). DM, HTN, and HTN + DM were present in 4.1%, 35.8% and 10.6% of patients, respectively. Compared to normal patients, HTN and HTN + DM patients had increased LVM indexed to body surface area (LVMi) (56.87 ± 17.24, 59.26 ± 13.62, and 58.56 ± 13.09, respectively; P < 0.05). There was no difference in LVMi between normal subjects and patients with DM (56.39 ± 11.50, P = 0.617).Concentricity indices were higher in patient with HTN (1.0456 ± 0.417; P < 0.001), DM (1.109 ± 0.638; P = 0.004), and HTN + DM (1.083 ± 0.311, P < 0.001) than normal individuals (0.9671 ± 0.361). There was no overlap of the 95% confidence intervals in the composite of concentricity indices and LVMi between the different groups. CONCLUSIONS CCTA measures of LVM and concentricity index may discriminate patients with HTN and DM before overt structural heart disease.
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Affiliation(s)
- Jeroen Walpot
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Joao R Inácio
- University of Ottawa, Department of Radiology, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Samia Massalha
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Alomgir Hossain
- University of Ottawa Heart Institute, Cardiovascular Research Methods Centre, Ottawa, ON, Canada
| | - Gary R Small
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Andrew M Crean
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Yeung Yam
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Frank Rybicki
- University of Ottawa, Department of Radiology, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Girish Dwivedi
- Harry Perkins Institute of Medical Research and Fiona Stanley Hospital, University of Western Australia, Perth, Australia
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
| | - Benjamin J W Chow
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, ON, Canada
- University of Ottawa, Department of Radiology, The Ottawa Hospital, Medical Imaging and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Subki AH, Bakhaidar MG, Bakhaider MA, Alkhowaiter AA, Al-Harbi RS, Almalki MA, Alzahrani KA, Fakeeh MM, Subki SH, Alhejily WA. Trends in mitral valve prolapse: a tertiary care center experience in Jeddah, Saudi Arabia. Int J Gen Med 2019; 12:55-61. [PMID: 30666148 PMCID: PMC6336028 DOI: 10.2147/ijgm.s177635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Mitral valve prolapse (MVP) is the most common cardiac valvular abnormality in developed countries and it is associated with considerable morbidity and mortality. Aim of work To study the clinical presentations, risk factors, and echocardiographic features of patients with MVP in Jeddah, Saudi Arabia. Materials and methods A retrospective chart review study was conducted in King Abdulaziz teaching hospital in Jeddah, Saudi Arabia, from 2007 to 2017. All patients with MVP who were admitted at the hospital during this time period were recruited to this study, and demographic, clinical, and echocardiographic variables were analyzed using IBM SPSS. Results Ninety-seven patients were recruited to this study, with a mean age of 43.82±16.16 years. Females constituted 67%. The body mass index (BMI) was 24.9±6.3 kg/m2. Hypertension, diabetes, and dyslipidemia occurred in 19.6%, 5.2%, and 5.2% of patients, respectively. A single patient had Marfan syndrome. Chest pain, palpitations, and dyspnea were the presenting symptoms in 23.7%, 11.3%, and 9.3% of patients, respectively, with elderly individuals presenting disproportionally (93.3%) with palpitations. Fifty-five percent of patients had an anterior leaflet prolapse. The presence of posterior leaflet prolapse and severe mitral regurgitation (MR) was significantly associated with left atrial and left ventricular dilatation (P<0.05 and P<0.001, respectively). Conclusion MVP is more prevalent in women and middle-aged individuals with normal BMIs in this population. The most common clinical presentations were chest pain, palpitations, and dyspnea, which did not differ significantly with age or gender. The anterior leaflet was the most commonly prolapsed in the studied patients and presented with mild MR. Posterior leaflet MVP, while of low prevalence, was associated with severe MR and poor left ventricular function.
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Affiliation(s)
- Ahmed Hussein Subki
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Mahmoud Ghaleb Bakhaidar
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | | | | | - Rakan Salah Al-Harbi
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Mohammed Ali Almalki
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Khalid Abdullah Alzahrani
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Maged Mazen Fakeeh
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Siham Hussein Subki
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
| | - Wesam Awad Alhejily
- Department of Internal Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,
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