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Ozturk M, Agaoglu Z, Ozturk FH, Yakut K, Öcal FD, Oguz Y, Caglar T. Evaluation of fetal myocardial performance index in gestational diabetes mellitus. Congenit Anom (Kyoto) 2023; 63:164-169. [PMID: 37494134 DOI: 10.1111/cga.12531] [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: 07/15/2022] [Revised: 04/22/2023] [Accepted: 06/04/2023] [Indexed: 07/28/2023]
Abstract
This study aimed to compare fetal myocardial performance index (MPI) between fetuses of pregnant women with gestational diabetes mellitus (GDM) and healthy controls and to evaluate the relationship between MPI and maternal glucose levels. This was a prospective study of 90 pregnant women, including 50 pregnancies with GDM (27 pregnancies with insulin-regulated GDM and 23 pregnancies with diet-regulated GDM) and 40 healthy controls. Isovolumetric contraction time (ICT) + isovolumetric relaxation time (IRT)/ejection time (ET) were used to calculate the MPI (MPI = [ICT + IRT]/ET). Fetal MPI, PR interval, E/A ratio, maternal plasma glucose levels on the day of MPI measurement, and neonatal outcomes were compared. The fetal left-MPI was significantly higher in the GDM group than healthy controls (0.43 ± 0.04 vs. 0.40 ± 0.06, p = 0.007). The best cut-off level for MPI was >0.41 to predict adverse perinatal outcomes (sensitivity: 70%, specificity: 68%, area under the curve: 0.715, 95% confidence interval: 0.5143-0.8205, p < 0.001). The fetal MPI values showed no correlation with maternal plasma fasting, postprandial glucose, and hemoglobin A1c (HbA1c) levels. Reduced E/A ratio, higher neonatal intensive care unit admissions, and the need for cesarean delivery were detected in the GDM group. Fetal MPI is impaired in women with GDM, and the need for insulin therapy is associated with higher MPI values and adverse neonatal outcomes. Fetal MPI can help detect fetuses with potential adverse outcome risks, owing to impaired fetal cardiac function.
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Affiliation(s)
- Merve Ozturk
- Department of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Zahid Agaoglu
- Department of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Filiz Halici Ozturk
- Department of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Kadriye Yakut
- Department of Perinatology, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Fatma Doğa Öcal
- Department of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Yuksel Oguz
- Department of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Turhan Caglar
- Department of Perinatology, Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
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Gilyarevsky SR, Golshmid MV, Kuzmina IM. [Not Available]. KARDIOLOGIIA 2018; 58:17-23. [PMID: 30625074 DOI: 10.18087/cardio.2018.11.10194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/24/2018] [Indexed: 06/09/2023]
Abstract
In this article we deal with the problem of low adherence of patients with ischemic heart disease (IHD) to drug therapy congruent to current recommendations including patients who underwent invasive interventions aimed at myocardial revascularization. Based on analysis of literature, we undertake an attempt to answer the question: which of components of this therapy patients with IHD are the least likely to continue taking? We also discuss approaches to the search for optimal composition of a combination preparation with fixed doses of an adreno-blocker and angiotensin converting enzyme inhibitor. Based on analysis of literature we undertook an attempt to answer a question: which of components of this therapy patients with IHD are least likely to continue taking. We also included in this article discussion of approaches to the search of optimal composition of a combination preparation containing fixed doses of a в-adrenoblocker and angiotensin converting enzyme inhibitor, as well as data on the role in the treatment of patients with IHD of bisoprolol and perindopril. Fixed doses of these agents have been included into a novel combination preparation.
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Abstract
PURPOSE OF REVIEW Type 2 diabetes mellitus (T2DM) is associated with increased coronary heart disease (CHD) morbidity and mortality. These patients are also more prone to heart failure, arrhythmias and sudden cardiac death. Furthermore, coronary interventions performed in such high-risk patients have worse outcomes. In this narrative review, we discuss the role of diabetic dyslipidaemia on the risk of CHD in patients with T2DM. The effects of hypolipidaemic, antihypertensive and antidiabetic drugs on lipid and glucose metabolism in T2DM are also considered. RECENT FINDINGS Among CHD risk factors, diabetic dyslipidaemia characterized by moderately elevated low-density lipoprotein (LDL) cholesterol, increased triglycerides and small, dense LDL particles as well as decreased high-density lipoprotein cholesterol levels may contribute to the increased CHD risk associated with T2DM. Hypolipidaemic, antihypertensive and antidiabetic drugs can affect lipid and glucose parameters thus potentially influencing CHD risk. Such drugs may improve not only the quantity, but also the quality of LDL as well as postprandial lipaemia. SUMMARY Current data highlight the importance of treating diabetic dyslipidaemia in order to minimize CHD risk. Both fasting and postprandial lipids are influenced by drugs in patients with T2DM; physicians should take this into consideration in clinical decision making.
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McAlister FA, Eurich DT, Majumdar SR, Johnson JA. The risk of heart failure in patients with type 2 diabetes treated with oral agent monotherapy. Eur J Heart Fail 2014; 10:703-8. [DOI: 10.1016/j.ejheart.2008.05.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 05/22/2008] [Accepted: 05/22/2008] [Indexed: 10/22/2022] Open
Affiliation(s)
- Finlay A. McAlister
- Division of General Internal Medicine, Department of Medicine; University of Alberta; Edmonton Alberta Canada
| | - Dean T. Eurich
- School of Public Health, University of Alberta; Edmonton Alberta Canada
| | - Sumit R. Majumdar
- Division of General Internal Medicine, Department of Medicine; University of Alberta; Edmonton Alberta Canada
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β-blockers in heart failure: breaking tradition to avoid diabetes? Heart Fail Clin 2012; 8:xiii-xvi. [PMID: 22999249 DOI: 10.1016/j.hfc.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Teupe C, Rosak C. Diabetic cardiomyopathy and diastolic heart failure -- difficulties with relaxation. Diabetes Res Clin Pract 2012; 97:185-94. [PMID: 22502812 DOI: 10.1016/j.diabres.2012.03.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 03/11/2012] [Accepted: 03/15/2012] [Indexed: 01/14/2023]
Abstract
Diabetic patients carry a four- to five-fold increased risk of heart failure. Hyperglycaemia plays a central role in the pathogenesis of diabetic cardiomyopathy. Diabetic cardiomyopathy represents a distinct structural and functional disorder of the myocardium characterized by cardiac hypertrophy and an increased myocardial stiffness. At an early stage, diabetic cardiomyopathy is manifested by diastolic heart failure with preserved ejection fraction. In some patients, diastolic dysfunction may progress to heart failure with reduced ejection fraction and result in overt systolic heart failure. Diastolic dysfunction can accurately be diagnosed by echocardiography and BNP measurement in daily clinical practice. Early treatment is prognostically important. Optimal control of blood glucose levels and blood pressure is beneficial. So far metformin is the only antidiabetic agent not associated with harm in diabetic patients with heart failure. Incretin-based therapies potentially provide cardiovascular benefits. ACE inhibitors, angiotensin-1 receptor antagonists and beta-blockers should be preferred in heart failure therapy.
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Affiliation(s)
- C Teupe
- Department of Internal Medicine and Cardiology, Krankenhaus Sachsenhausen, Teaching Hospital, Goethe University, Frankfurt, Germany.
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Figueroa H, Silva MC, Kottmann C, Viguera S, Valenzuela I, Hernandez-Andrade E, Gratacos E, Arraztoa JA, Illanes SE. Fetal evaluation of the modified-myocardial performance index in pregnancies complicated by diabetes. Prenat Diagn 2012; 32:943-8. [DOI: 10.1002/pd.3937] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 06/12/2012] [Accepted: 06/12/2012] [Indexed: 11/12/2022]
Affiliation(s)
- Horacio Figueroa
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
- Department of Maternal-Fetal Medicine, Clínica Davila; Santiago Chile
| | - Maria Carolna Silva
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
| | - Cristian Kottmann
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
- Department of Maternal-Fetal Medicine, Clínica Davila; Santiago Chile
| | - Sebastian Viguera
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
| | - Ignacio Valenzuela
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
| | - Edgar Hernandez-Andrade
- Clinic Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic, and Fetal and Perinatal Medicine Group, Institutd' Investigacions Biomediques Augus Pii Sunyer (IDIBAPS); Universidad de Barcelona; Spain
| | - Eduard Gratacos
- Clinic Institute of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic, and Fetal and Perinatal Medicine Group, Institutd' Investigacions Biomediques Augus Pii Sunyer (IDIBAPS); Universidad de Barcelona; Spain
| | - Jose Antonio Arraztoa
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
- Department of Maternal-Fetal Medicine, Clínica Davila; Santiago Chile
| | - Sebastián E. Illanes
- Department of Obstetrics & Gynecology and Laboratory of Reproductive Biology; Universidad de Los Andes; Chile
- Department of Maternal-Fetal Medicine, Clínica Davila; Santiago Chile
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Rutten FH. β-blockers and their mortality benefits: underprescribed in heart failure and chronic obstructive pulmonary disease. Future Cardiol 2011; 7:43-53. [DOI: 10.2217/fca.10.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This article discusses the most recent insights into the actions of β-blockers on the heart and lungs, highlighting that β-blockers should have a place in the treatment of patients with chronic obstructive pulmonary disease (COPD), especially in those with coexisting cardiovascular disease or arterial hypertension. Practical studies clearly show underutilization of β-blockers in patients with heart failure and COPD, which seems to be caused by an unnecessary fear for adverse effects on the lungs, and the ‘outdated’ adverse effects mentioned on instruction leaflets.
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Affiliation(s)
- Frans H Rutten
- Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, PO Box 85060, Stratenum 6.101, 3508 AB Utrecht, The Netherlands
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McGill JB. Optimal use of beta-blockers in high-risk hypertension: a guide to dosing equivalence. Vasc Health Risk Manag 2010; 6:363-72. [PMID: 20539838 PMCID: PMC2882888 DOI: 10.2147/vhrm.s6668] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Indexed: 01/13/2023] Open
Abstract
Hypertension is the number one diagnosis made by primary care physicians, placing them in a unique position to prescribe the antihypertensive agent best suited to the individual patient. In individuals with diabetes mellitus, blood pressure (BP) levels >130/80 mmHg confer an even higher risk for cardiovascular and renal disease, and these patients will benefit from aggressive antihypertensive treatment using a combination of agents. β-blockers are playing an increasingly important role in the management of hypertension in high-risk patients. β-blockers are a heterogeneous class of agents, and this review presents the differences between β-blockers and provides evidence-based protocols to assist in understanding dose equivalence in the selection of an optimal regimen in patients with complex needs. The clinical benefits provided by β-blockers are only effective if patients adhere to medication treatment long term. β-blockers with proven efficacy, once-daily dosing, and lower side effect profiles may become instrumental in the treatment of hypertensive diabetic and nondiabetic patients.
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Affiliation(s)
- Janet B McGill
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Frishman WH, Henderson LS, Lukas MA. Controlled-release carvedilol in the management of systemic hypertension and myocardial dysfunction. Vasc Health Risk Manag 2009; 4:1387-400. [PMID: 19337551 PMCID: PMC2663448 DOI: 10.2147/vhrm.s3148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cardiovascular disease is the leading cause of death worldwide. Within the treatment armamentarium, beta-blockers have demonstrated efficacy across the spectrum of cardiovascular disease--from modification of a risk factor (ie, hypertension) to treatment after an acute event (ie, myocardial infarction). Recently, the use of beta-blockers as a first-line therapy in hypertension has been called into question. Moreover, beta-blockers as a class are saddled with a misperception of having poor tolerability. However, vasodilatory beta-blockers such as carvedilol have a different hemodynamic action that provides the benefits of beta-blockade with the addition of vasodilation resulting from alpha 1-adrenergic receptor blockade. Vasodilation reduces total peripheral resistance, which may produce an overall positive effect on tolerability. Recently, a new, controlled-release carvedilol formulation has been developed that provides the clinical efficacy of carvedilol but is indicated for once-daily dosing. This review presents an overview of the clinical and pharmacologic carvedilol controlled-release data.
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Affiliation(s)
- William H Frishman
- Departments of Medicine and Pharmacology, New York Medical College/Westchester Medical Center, Valhalla, NY 10595, USA.
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Konstantino Y, Chen E, Hasdai D, Boyko V, Battler A, Behar S, Haim M. Gender differences in mortality after acute myocardial infarction with mild to moderate heart failure. ACTA ACUST UNITED AC 2007; 9:43-7. [PMID: 17453538 DOI: 10.1080/17482940601100819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Heart failure (HF) is associated with poor outcome after acute myocardial infarction (AMI). Women have higher mortality rate than men after AMI, however, it is unknown whether women with HF after AMI have different prognosis than men. AIM To compare the prognosis of men and women with AMI and mild-moderate HF. METHODS We analyzed data of 3456 consecutive patients with AMI hospitalized in all cardiac care units in Israel during two nationwide surveys. RESULTS Among patients with AMI and HF on admission: women were older, had more risk factors, and were less likely to undergo percutaneous coronary angiography/intervention. Women with HF had higher (7-days, 30-days, and 1-year) crude mortality rates than men. However, adjusted mortality rates were not significantly different between genders. CONCLUSIONS Women with AMI complicated by HF had higher crude mortality rate than men that was eliminated after multivariate analysis, suggesting that the higher mortality rate may be attributed to increased prevalence of risk factors and lower rate of revascularization and medical therapies among women. Women with AMI and HF should be considered as a high-risk subgroup with adverse outcome. It remains to be determined whether more intensive management will improve their prognosis.
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Affiliation(s)
- Yuval Konstantino
- Cardiology Department, Rabin Medical Center, Beilinmson Campus, Jabotinsky St., Petah-Tikva 49100, Israel.
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Bakris GL, Tarka EA, Waterhouse B, Goulding MR, Madan A, Anderson KM, St John Sutton M, Miller AB, Reichek N. Cardiovascular risk factors in hypertension: rationale and design of studies to investigate the effects of controlled-release carvedilol on regression of left ventricular hypertrophy and lipid profile. Am J Cardiol 2006; 98:46L-52L. [PMID: 17023232 DOI: 10.1016/j.amjcard.2006.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients at high risk for hypertension may require several therapeutic agents to lower their blood pressure to guideline-recommended targets. Some antihypertensive agents are more effective than others in protecting against cardiovascular morbidity and mortality. Numerous beta-blocking agents have been approved by the US Food and Drug Administration (FDA) for the treatment of hypertension. Previous trials have demonstrated that although all beta-blockers effectively reduce blood pressure, there are differences in how they affect various metabolic factors. In 2 trials, a novel controlled-release (CR) formulation of carvedilol will be tested against other selective beta-blockers to determine whether differences exist in their individual effects on cardiovascular risk factors. These will be the first head-to-head trials using carvedilol CR to determine whether the differing pharmacologic actions among beta-blockers result in varying effects on cardiovascular risk factors.
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Affiliation(s)
- George L Bakris
- Hypertension Unit, Section of Endocrinology, Diabetes, and Metabolism, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA.
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Gilbert RE, Connelly K, Kelly DJ, Pollock CA, Krum H. Heart Failure and Nephropathy: Catastrophic and Interrelated Complications of Diabetes. Clin J Am Soc Nephrol 2005; 1:193-208. [PMID: 17699208 DOI: 10.2215/cjn.00540705] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Heart failure (HF) is a major contributor to poor quality of life, a leading cause of hospitalization, and cause of premature death. Both kidney disease and diabetes are major and independent risk factors for the development of heart failure, such that individuals with diabetic nephropathy are at especially high risk. Such patients not only are likely to have coronary artery disease and hypertension but also are likely to have diabetic cardiomyopathy, a distinct pathologic entity that is more closely associated with the microvascular than the macrovascular complications of diabetes. In addition to a better understanding of the epidemiology of HF, advances in noninvasive imaging have highlighted the importance of early cardiac dysfunction in diabetes and the high prevalence of HF with preserved left ventricular systolic function. Although significant renal dysfunction is usually an exclusion criterion in HF trials, diabetes is often a prespecified subgroup so that subanalyses of large multicenter clinical trials do provide some guidance in therapeutic decision-making. However, further therapies for both HF and nephropathy in diabetes clearly are needed, and a number of new therapeutic strategies that target both disorders have already entered the clinical arena.
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Affiliation(s)
- Richard E Gilbert
- University of Melbourne Department of Medicine, St. Vincent's Hospital, Victoria, Australia.
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Cook SA, Aitman T, Naoumova RP. Therapy insight: heart disease and the insulin-resistant patient. ACTA ACUST UNITED AC 2005; 2:252-60. [PMID: 16265509 DOI: 10.1038/ncpcardio0194] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Accepted: 03/29/2005] [Indexed: 01/11/2023]
Abstract
Insulin-resistance syndromes are of pandemic proportions; 150 million people worldwide and an estimated 43 million people in the US are currently affected by type 2 diabetes mellitus or metabolic syndrome respectively. Treatment of heart disease in the context of type 2 diabetes requires multifactorial risk-factor management, including lifestyle modification and drug treatment for comorbidities. Management of coronary risk extends beyond simple cholesterol lowering. Early use of cardiac imaging and, where appropriate, revascularization should be considered in high-risk or symptomatic patients. Traditionally, patients with type 2 diabetes and coronary arterial disease have been treated surgically, but percutaneous revascularization of these patients is increasingly common. Indeed, revascularization by use of drug-eluting coronary stents combined with administration of novel antiplatelet agents has revolutionized percutaneous coronary intervention in patients with type 2 diabetes. Despite these advances, there is no consensus of opinion regarding revascularization strategies or risk-factor management in insulin-resistant patients with symptomatic or prognostically important coronary arterial disease. Furthermore, specific therapies and preventative strategies for diabetic cardiomyopathy and heart failure in patients with type 2 diabetes remain elusive. The identification of optimized approaches for the prevention and treatment of the metabolic syndrome and heart disease in insulin-resistant, nondiabetic patients remains a major global challenge.
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Affiliation(s)
- Stuart A Cook
- Clinical Cardiology at the Imperial College Faculty of Medicine, London, UK.
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