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Pua CJ, Loo G, Kui M, Moy WL, Hii AA, Lee V, Chin CT, Bryant JA, Toh DF, Lee CH, Cook SA, Richards AM, Le TT, Chin CWL. Impact of Diabetes on Myocardial Fibrosis in Patients With Hypertension: The REMODEL Study. Circ Cardiovasc Imaging 2023:e015051. [PMID: 37431660 DOI: 10.1161/circimaging.123.015051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
BACKGROUND Compared with patients with hypertension only, those with hypertension and diabetes (HTN/DM) have worse prognosis. We aimed to characterize morphological differences between hypertension and HTN/DM using cardiovascular magnetic resonance; and compare differentially expressed proteins associated with myocardial fibrosis using high throughput multiplex assays. METHODS Asymptomatic patients underwent cardiovascular magnetic resonance: 438 patients with hypertension (60±8 years; 59% males) and 167 age- and sex-matched patients with HTN/DM (60±10 years; 64% males). Replacement myocardial fibrosis was defined as nonischemic late gadolinium enhancement on cardiovascular magnetic resonance. Extracellular volume fraction was used as a marker of diffuse myocardial fibrosis. A total of 184 serum proteins (Olink Target Cardiovascular Disease II and III panels) were measured to identify unique signatures associated with myocardial fibrosis in all patients. RESULTS Despite similar left ventricular mass (P=0.344) and systolic blood pressure (P=0.086), patients with HTN/DM had increased concentricity and worse multidirectional strain (P<0.001 for comparison of all strain measures) compared to hypertension only. Replacement myocardial fibrosis was present in 28% of patients with HTN/DM compared to 16% of those with hypertension (P<0.001). NT-proBNP (N-terminal pro-B-type natriuretic peptide) was the only protein differentially upregulated in hypertension patients with replacement myocardial fibrosis and independently associated with extracellular volume. In patients with HTN/DM, GDF-15 (growth differentiation factor 15) was independently associated with replacement myocardial fibrosis and extracellular volume. Ingenuity Pathway Analysis demonstrated a strong association between increased inflammatory response/immune cell trafficking and myocardial fibrosis in patients with HTN/DM. CONCLUSIONS Adverse cardiac remodeling was observed in patients with HTN/DM. The novel proteomic signatures and associated biological activities of increased immune and inflammatory response may partly explain these observations.
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Affiliation(s)
- Chee Jian Pua
- National Heart Research Institute of Singapore, Singapore (C.J.P, A.-A.H., V.L., D.-F.T., S.A.C., T.-T.L., C.W.L.C.)
| | - Germaine Loo
- Department of Cardiology, National Heart Centre Singapore, Singapore. (G.L., M.K., C.-TC., J.A.B., S.A.C., C.W.L.C.)
| | - Michelle Kui
- Department of Cardiology, National Heart Centre Singapore, Singapore. (G.L., M.K., C.-TC., J.A.B., S.A.C., C.W.L.C.)
| | - Wai Lun Moy
- Department of Internal Medicine, Sengkang General Hospital, Singapore (W.L.M.)
| | - An-An Hii
- National Heart Research Institute of Singapore, Singapore (C.J.P, A.-A.H., V.L., D.-F.T., S.A.C., T.-T.L., C.W.L.C.)
| | - Vivian Lee
- National Heart Research Institute of Singapore, Singapore (C.J.P, A.-A.H., V.L., D.-F.T., S.A.C., T.-T.L., C.W.L.C.)
| | - Chee-Tang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore. (G.L., M.K., C.-TC., J.A.B., S.A.C., C.W.L.C.)
| | - Jennifer A Bryant
- Department of Cardiology, National Heart Centre Singapore, Singapore. (G.L., M.K., C.-TC., J.A.B., S.A.C., C.W.L.C.)
| | - Desiree-Faye Toh
- National Heart Research Institute of Singapore, Singapore (C.J.P, A.-A.H., V.L., D.-F.T., S.A.C., T.-T.L., C.W.L.C.)
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore (C.-H.L.)
| | - Stuart A Cook
- National Heart Research Institute of Singapore, Singapore (C.J.P, A.-A.H., V.L., D.-F.T., S.A.C., T.-T.L., C.W.L.C.)
- Department of Cardiology, National Heart Centre Singapore, Singapore. (G.L., M.K., C.-TC., J.A.B., S.A.C., C.W.L.C.)
- Cardiovascular & Metabolic Disorders Program, Duke-NUS Medical School, Singapore (S.A.C.)
| | - A Mark Richards
- Cardiovascular Research Institute, National University Heart Centre Singapore, Singapore (AMR)
- Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.)
| | - Thu-Thao Le
- National Heart Research Institute of Singapore, Singapore (C.J.P, A.-A.H., V.L., D.-F.T., S.A.C., T.-T.L., C.W.L.C.)
- Cardiovascular ACP, Duke-NUS Medical School, Singapore (T.-T.L., C.W.L.C.)
| | - Calvin W L Chin
- National Heart Research Institute of Singapore, Singapore (C.J.P, A.-A.H., V.L., D.-F.T., S.A.C., T.-T.L., C.W.L.C.)
- Department of Cardiology, National Heart Centre Singapore, Singapore. (G.L., M.K., C.-TC., J.A.B., S.A.C., C.W.L.C.)
- Cardiovascular ACP, Duke-NUS Medical School, Singapore (T.-T.L., C.W.L.C.)
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