1
|
Zulet P, Islas F, Ferrández-Escarabajal M, Bustos A, Cabeza B, Gil-Abizanda S, Vidal M, Martín-Lores I, Hernández-Mateo P, de Agustín JA, Olmos C. Diabetes mellitus is associated to high-risk late gadolinium enhancement and worse outcomes in patients with nonischemic dilated cardiomyopathy. Cardiovasc Diabetol 2024; 23:35. [PMID: 38245750 PMCID: PMC10800059 DOI: 10.1186/s12933-024-02127-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with a worse prognosis in patients with heart failure. Our aim was to analyze the clinical and imaging features of patients with DM and their association with outcomes in comparison to nondiabetic patients in a cohort of patients with nonischemic dilated cardiomyopathy (DCM). METHODS This is a prospective cohort study of patients with DCM evaluated in a tertiary care center from 2018 to 2021. Transthoracic echocardiography and cardiac magnetic resonance findings were assessed. A high-risk late gadolinium enhancement (LGE) pattern was defined as epicardial, transmural, or septal plus free-wall. The primary outcome was a composite of heart failure hospitalizations and all-cause mortality. Multivariable analyses were performed to evaluate the impact of DM on outcomes. RESULTS We studied 192 patients, of which 51 (26.6%) had DM. The median left ventricular ejection fraction was 30%, and 106 (55.2%) had LGE. No significant differences were found in systolic function parameters between patients with and without DM. E/e values were higher (15 vs. 11.9, p = 0.025), and both LGE (68.6% vs. 50.4%; p = 0.025) and a high-risk LGE pattern (31.4% vs. 18.5%; p = 0.047) were more frequently found in patients with DM. The primary outcome occurred more frequently in diabetic patients (41.2% vs. 23.6%, p = 0.017). DM was an independent predictor of outcomes (OR 2.01; p = 0.049) and of LGE presence (OR 2.15; p = 0.048) in the multivariable analysis. Patients with both DM and LGE had the highest risk of events (HR 3.1; p = 0.003). CONCLUSION DM is related to a higher presence of LGE in DCM patients and is an independent predictor of outcomes. Patients with DM and LGE had a threefold risk of events. A multimodality imaging approach allows better risk stratification of these patients and may influence therapeutic options.
Collapse
Affiliation(s)
- Pablo Zulet
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martín Lagos s/n, Madrid, 28040, Spain
| | - Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martín Lagos s/n, Madrid, 28040, Spain
| | - Marcos Ferrández-Escarabajal
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martín Lagos s/n, Madrid, 28040, Spain
| | - Ana Bustos
- Servicio de Diagnóstico por la Imagen, Hospital Clínico San Carlos, Madrid, Spain
| | - Beatriz Cabeza
- Servicio de Diagnóstico por la Imagen, Hospital Clínico San Carlos, Madrid, Spain
| | - Sandra Gil-Abizanda
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martín Lagos s/n, Madrid, 28040, Spain
| | - María Vidal
- Servicio de Diagnóstico por la Imagen, Hospital Clínico San Carlos, Madrid, Spain
| | - Irene Martín-Lores
- Servicio de Diagnóstico por la Imagen, Hospital Clínico San Carlos, Madrid, Spain
| | | | - J Alberto de Agustín
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martín Lagos s/n, Madrid, 28040, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/Profesor Martín Lagos s/n, Madrid, 28040, Spain.
- Universidad Europea de Madrid, Madrid, Spain.
| |
Collapse
|
2
|
Real C, Ramos N, Fernández-Vega A, Vivas D, Ortega-Candil A, Nava-Muñoz Á, Hernández-Mateo P, Rodríguez-Rey C, Juez A, Vilacosta I. Successful Conservative Treatment of a Large Infected Saphenous Graft Aneurysm: Usefulness of PET/CT. JACC Case Rep 2020; 2:764-768. [PMID: 34317344 PMCID: PMC8301699 DOI: 10.1016/j.jaccas.2020.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 12/16/2022]
Abstract
We report a case of a 75-year-old man with a medical history of coronary artery bypass graft surgery and a recent graft angioplasty, who presented to our emergency department with fever. An 18F-fluorodeoxyglucose positron emission tomography demonstrated a saphenous graft infected aneurysm, which was successfully treated conservatively with antibiotic therapy. (Level of Difficulty: Beginner.).
Collapse
Affiliation(s)
- Carlos Real
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Noemí Ramos
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - David Vivas
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Aida Ortega-Candil
- Department of Nuclear Medicine, Hospital Clínico San Carlos, Madrid, Spain
| | - Ángel Nava-Muñoz
- Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Almudena Juez
- Department of Nephrology, Hospital Clínico San Carlos, Madrid, Spain
| | - Isidre Vilacosta
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| |
Collapse
|