Association of Inflammatory and Metabolic Biomarkers with Mitral Annular Calcification in Type 2 Diabetes Patients

Abstract

(1) Background: Type 2 diabetes mellitus (T2DM) contributes to cardiovascular disease and related mortality through the insidious effects of insulin resistance and chronic inflammation. Mitral annular calcification (MAC) is one such degenerative process promoted by T2DM. (2) Methods: This is a post hoc analysis of insulin resistance, inflammation, and hepatic steatosis markers in T2DM patients without atherosclerotic manifestations, but with incidental echocardiographic detection of mild MAC. (3) Results: 138 consenting patients were 49.3% men, 57.86 years old, with a history of T2DM of 6.16 years and HbA1c 8.06%, of whom sixty had mild MAC (43.47%). The statistically significant differences between patients with/without MAC were higher HOMA C-peptide and C-peptide index for insulin resistance, higher TNF-α for inflammation, and lower estimated glomerular filtration rate. High-sensitive C-reactive protein (hsCRP) was significantly associated with insulin resistance and the strength of the relationship was higher in the MAC group. Predictive of MAC were TNF-α, HOMA C-peptide, and especially hepatic steatosis and hypertension. (4) Conclusions: MAC was more prevalent than reported in the literature. Insulin resistance and inflammation were predictive of MAC, but significant markers differ across studies. Widely available routine tests and echocardiographic assessments are useful in the early identification of mitral annular calcifications in diabetes patients.

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“…Atrial flutter and fibrillation, as well as AV block and sinus tachycardia, might also result from myocardial ischemia, left ventricular systolic and/or diastolic dysfunction, pulmonary embolism, acute respiratory distress syndrome and even a direct action of the virus upon the conduction system. 191 , 199 …”

“…Atrial flutter and fibrillation, as well as AV block and sinus tachycardia, might also result from myocardial ischemia, left ventricular systolic and/or diastolic dysfunction, pulmonary embolism, acute respiratory distress syndrome and even a direct action of the virus upon the conduction system. 191,199 Supraventricular arrhythmias are also frequently documented in COVID-19 patients. A recent systematic review and meta-analysis revealed a 10.3% prevalence of overall ECG abnormalities among COVID-19 patients.…”