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Madsen NL, Haley JE, Moore RA, Khoury PR, Urbina EM. Increased Arterial Stiffness Is Associated With Reduced Diastolic Function in Youth With Obesity and Type 2 Diabetes. Front Pediatr 2021; 9:781496. [PMID: 34912763 PMCID: PMC8666894 DOI: 10.3389/fped.2021.781496] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Increased arterial stiffness is associated with diastolic dysfunction in adults. Data in youth are lacking, so we examined the impact of arterial stiffness on diastolic function in youth. Methods: We obtained diastolic function and augmentation index, pulse wave velocity, brachial artery distensibility, and carotid stiffness on 612 youth [10-24 years, 65% female, 38% normal weight, 36% obese, and 26% with type 2 diabetes mellitus (T2DM)]. Participants were classified as compliant (C) vs. stiff (S) arteries based on seven arterial stiffness parameters [Global Stiffness Index (GSI), S = GSI > 4). Mean differences in covariates were evaluated by Student's t-tests. A stepwise regression analysis was performed to determine if GSI was an independent predictor of diastolic function. Results: Lower diastolic function and more adverse cardiovascular disease (CVD) risk factors were present in the S group (n = 67) than the C group (n = 545) (p < 0.001). Covariates that were associated with diastolic dysfunction were higher GSI, male sex, higher body mass index (BMI), and systolic blood pressure (SBP) z-score (R 2 = 0.18 to 0.25; p ≤ 0.05). Conclusion: Adverse diastolic function is seen in youth with increased arterial stiffness independent of CVD risk factors. Interventions to improve arterial stiffness prior to clinical onset of diastolic dysfunction are needed to prevent development of heart failure.
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Affiliation(s)
- Nicolas L Madsen
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jessica E Haley
- Department of Pediatrics, Rady Children's Hospital, San Diego, CA, United States
| | - Ryan A Moore
- The Heart Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States
| | - Philip R Khoury
- The Heart Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States
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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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Gulsin GS, Athithan L, McCann GP. Diabetic cardiomyopathy: prevalence, determinants and potential treatments. Ther Adv Endocrinol Metab 2019; 10:2042018819834869. [PMID: 30944723 PMCID: PMC6437329 DOI: 10.1177/2042018819834869] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/08/2019] [Indexed: 12/18/2022] Open
Abstract
The prevalence of type 2 diabetes (T2D) has reached a pandemic scale. These patients are at a substantially elevated risk of developing cardiovascular disease, with heart failure (HF) being a leading cause of morbidity and mortality. Even in the absence of traditional risk factors, diabetes still confers up to a twofold increased risk of developing HF. This has led to identifying diabetes as an independent risk factor for HF and recognition of the distinct clinical entity, diabetic cardiomyopathy. Despite a wealth of research interest, the prevalence and determinants of diabetic cardiomyopathy remain uncertain. This limited understanding of the pathophysiology of diabetic heart disease has also hindered development of effective treatments. Tight blood-glucose and blood-pressure control have not convincingly been shown to reduce macrovascular outcomes in T2D. There is, however, emerging evidence that T2D is reversible and that the metabolic abnormalities can be reversed with weight loss. Increased aerobic exercise capacity is associated with significantly lower cardiovascular and overall mortality in diabetes. Whether such lifestyle modifications as weight loss and exercise may ameliorate the structural and functional derangements of the diabetic heart has yet to be established. In this review, the link between T2D and myocardial dysfunction is explored. Insights into the structural and functional perturbations that typify the diabetic heart are first described. This is followed by an examination of the pathophysiological mechanisms that contribute to the development of cardiovascular disease in T2D. Lastly, the current and emerging therapeutic strategies to prevent or ameliorate cardiac dysfunction in T2D are evaluated.
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Affiliation(s)
- Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
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Zoppini G, Bergamini C, Mantovani A, Dauriz M, Targher G, Rossi A, Bonora E. The E/e' ratio difference between subjects with type 2 diabetes and controls. A meta-analysis of clinical studies. PLoS One 2018; 13:e0209794. [PMID: 30589892 PMCID: PMC6307698 DOI: 10.1371/journal.pone.0209794] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/11/2018] [Indexed: 01/07/2023] Open
Abstract
Type 2 diabetes is associated with an increased risk of heart failure. Left ventricular diastolic dysfunction and type 2 diabetes are frequently associated. Using echocardiography, we know that tissue Doppler imaging E/e’ ratio is a reliable predictor of left ventricular filling pressure. We performed a systematic review and meta-analysis to investigate the averaged E/e’ ratio value in patients with type 2 diabetes compared to non-diabetic controls. In the analysis we included cross-sectional studies providing the averaged E/e’ ratio. Subgroup/sensitivity analyses were conducted according to variables known to influence E/e’ ratio measurements. The analysis included 15 cross sectional studies with 877 type 2 diabetes patients and 1193 controls. The weighted mean difference showed higher values in diabetes (WMD 2.02; 95% CI 1.35, 2.70; p<0.001). The result was consistent in the subgroup/sensitivity analyses. Visual inspection of the funnel plot did not identify substantial asymmetry and the Egger test for funnel plot asymmetry showed a p value of 0.36. In conclusion, our assessment suggests that averaged E/e’ ratio is consistently increased in patients with type 2 diabetes compared to non-diabetic controls in the absence of cardiovascular diseases and complicated hypertension. This alteration may be a precocious diastolic alteration in the diabetic cardiomyopathy.
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Affiliation(s)
- Giacomo Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
- * E-mail:
| | - Corinna Bergamini
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Marco Dauriz
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Andrea Rossi
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
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Wentzel A, Malan L, Scheepers JD, Malan NT. QTc prolongation, increased NT-proBNP and pre-clinical myocardial wall remodeling in excessive alcohol consumers: The SABPA study. Alcohol 2018; 68:1-8. [PMID: 29413668 DOI: 10.1016/j.alcohol.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 12/26/2022]
Abstract
Alcohol contributes greatly to vascular and structural modifications. Due to differences in the metabolism and tolerance of alcohol between ethnic groups, the manner of these modifications may differ. We investigated the association between alcohol consumption - measured via ethnic-specific gamma glutamyl transferase (γ-GT) cut-points - and markers of cardiac perfusion, electrical activity, and pre-clinical structural alterations. A South African target population study was performed in a bi-ethnic cohort (n = 405). Alcohol consumption was determined according to previously defined ethnic-specific γ-GT cut-points, where γ-GT ≥ 19.5 U/L and γ-GT ≥ 55 U/L indicated excessive alcohol consumption in Caucasians and Africans, respectively. Ambulatory 24-h blood pressure and electrocardiograms (ECG), 10-lead ECG left ventricular hypertrophy (LVH), ischemic events, N-terminal pro-brain natriuretic peptide (NT-proBNP), and QTc prolongation were assessed. Fasting blood samples were obtained. A poorer cardio-metabolic profile and mean 24-h hypertensive and ECG-LVH values were evident in high γ-GT groups of both ethnicities, when compared to their low counterparts. The African high γ-GT group reported a higher intake of alcohol and presented significant increases in NT-proBNP (p < 0.001), QTc prolongation (p = 0.008), and ischemic events (p = 0.013). Regression analyses revealed associations between ECG-LVH and NT-proBNP, QTc prolongation, ischemic events, and SBP, in the African high γ-GT group exclusively. High alcohol consumers presented delayed electrical conduction in the heart accompanied by ECG-LVH, ischemic events, and increased vaso-responsiveness, predominantly in Africans. Ultimately, increased left ventricular distension on a pre-clinical level may elevate the risk for future cardiovascular events in this population.
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Zencirci E, Yeşilaltay A, Yağız V, Değirmencioğlu A, Zencirci AE, Buturak A. Myocardial functional abnormalities and serum N-terminal pro-brain natriuretic peptide in type II diabetes mellitus patients with cardiovascular autonomic neuropathy. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-016-0484-7] [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: 10/22/2022] Open
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Predictors of left ventricular diastolic dysfunction in type 2 diabetes patients: A 4-year prospective study. Hellenic J Cardiol 2016; 57:457-458. [DOI: 10.1016/j.hjc.2016.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 07/06/2016] [Indexed: 01/16/2023] Open
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Zhou L, Cai X, Li M, Han X, Ji L. Plasma NT-proBNP is independently associated with albuminuria in type 2 diabetes. J Diabetes Complications 2016; 30:669-74. [PMID: 26922580 DOI: 10.1016/j.jdiacomp.2016.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of this study is to investigate the relationship between plasma NH2-terminal pro-brain natriuretic peptide (NT-proBNP) levels and diabetic nephropathy in type 2 diabetic patients. METHODS The records of 983 patients with type 2 diabetes hospitalized in the Endocrinology and Metabolism Department of Peking University People's Hospital between January 2009 and December 2012 were reviewed. Based on their urinary albumin-to-creatinine ratio (UACR), the subjects were divided into three groups, those with normal, micro- and macro-albuminuria. Clinical manifestations and biochemical parameters, including plasma NT-proBNP concentrations, were compared between the three groups. The association between plasma NT-proBNP levels and stages of diabetic nephropathy was also evaluated by ordinal and stepwise linear regression analyses. RESULTS The median plasma NT-proBNP concentration in the 983 patients with type 2 diabetes was 60.3 pg/ml, which is within the normal range of healthy subjects. One-way ANOVA analysis showed significant differences in plasma NT-proBNP concentrations among the three groups (p=0.000). Ordinal logistic regression analysis showed that plasma NT-proBNP concentration was an independent risk factor for advanced diabetic nephropathy (odds ratio=1.87,95% CI 1.52-2.29, p=0.000). Plasma NT-proBNP concentration was highly correlated with UACR (r=0.421, p=0.000) and had an independently positive association with UACR by stepwise linear regression analysis (p=0.000). CONCLUSION Plasma NT-proBNP levels correlated with the degree of diabetic nephropathy in patients with type 2 diabetes.
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Affiliation(s)
- Lingli Zhou
- Peking University People's Hospital, Beijing, China
| | - Xiaoling Cai
- Peking University People's Hospital, Beijing, China
| | - Minghui Li
- Peking University People's Hospital, Beijing, China
| | - Xueyao Han
- Peking University People's Hospital, Beijing, China
| | - Linong Ji
- Peking University People's Hospital, Beijing, China.
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Fasudil improves short-term echocardiographic parameters of diastolic function in patients with type 2 diabetes with preserved left ventricular ejection fraction: a pilot study. Heart Vessels 2014; 30:89-97. [PMID: 24390764 DOI: 10.1007/s00380-013-0458-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/20/2013] [Indexed: 01/01/2023]
Abstract
Left ventricular (LV) diastolic dysfunction is observed frequently in patients with type 2 diabetes; however, few studies have focused on the effect of the Rho-associated kinase inhibitor fasudil on cardiac performance in humans. We conducted a prospective pilot study to assess the impact of fasudil on LV diastolic function in patients with diabetes without systolic dysfunction. Two hundred and fifty eligible patients with type 2 diabetes (149 men [61.3 %] and 94 women [38.7 %]) with a mean age of 57.2 years were randomly assigned to fasudil (n = 122, 30 mg intravenously twice a day for 14 days) or placebo (n = 121) groups. Echocardiographic variables were measured at the baseline and 1 month after the intervention. Compared with the placebo group, the fasudil group showed a significant decrease in diastolic blood pressure and in the peak of late diastolic transmitral flow (Am) (P < 0.05 for both). Deceleration time (DT), isovolumic relaxation time (IVRT), the peak of early diastolic annular velocity (e'), the peak of late diastolic annular velocity, and E/e' also exhibited a significant improvement (all, P < 0.05) after fasudil administration. Furthermore, the Em/Am ratio and IVRT, DT, and E/e' values recorded after fasudil treatment in the subgroup with impaired LV relaxation significantly differed from the corresponding values in the subgroup with normal LV relaxation (all, P < 0.05). Fasudil improves short-term echocardiographic parameters of LV diastolic function in patients with type 2 diabetes with preserved left ventricular ejection fraction.
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