Associations of (pre)diabetes with right ventricular and atrial structure and function: the Maastricht Study

Abstract

Backgrounds: The role of right ventricular (RV) and atrial (RA) structure and function, in the increased heart failure risk in (pre)diabetes is incompletely understood. The purpose of this study is to investigate the associations between (pre)diabetes and RV and RA structure and function, and whether these are mediated by left ventricular (LV) alterations or pulmonary pressure. Methods: Participants of the Maastricht Study; a population-based cohort study (426 normal glucose metabolism (NGM), 142 prediabetes, 224 diabetes), underwent two-dimensional and tissue Doppler echocardiography. Multiple linear regression analyses with pairwise comparisons of (pre)diabetes versus NGM, adjusted for cardiovascular risk factors, and mediation analyses were used. Results: In general, differences were small. Nevertheless, in individuals with prediabetes and diabetes compared to NGM; RA volume index was lower (both p < 0.01, p trend < 0.01), RV diameter was lower (both p < 0.01, p trend < 0.01) and RV length was significantly smaller in diabetes (p = 0.67 and p = 0.03 respectively, p trend = 0.04), TDI S′RV was lower (p = 0.08 and p < 0.01 respectively, p trend < 0.01), TDI E′RV was lower (p = 0.01 and p = 0.02 respectively, p trend = 0.01) and TDI A′RV was lower (p < 0.01 and p = 0.07 respectively, p trend = 0.04). Only the differences in RA volume index (7.8%) and RV diameter (6.2%) were mediated by the maximum tricuspid gradient, but no other LV structure and function measurements. Conclusions: (Pre)diabetes is associated with structural RA and RV changes, and impaired RV systolic and diastolic function, independent of cardiovascular risk factors. These associations were largely not mediated by indices of LV structure, LV function or pulmonary pressure. This suggests that (pre)diabetes affects RA and RV structure and function due to direct myocardial involvement.

Impaired right ventricular filling in patients with a chronic coronary syndrome

“…Since RVDD occurs before RV systolic dysfunction, it is not surprising that RVDD is more frequent in comparison with RV systolic dysfunction, which was noted in our study. Also, among the reasons for the detection of RVDD, a direct adverse effect of pathophysiological factors on the RV myocardium is considered [18]. Since the RV has, in comparison with the LV, a lower mass (ie, lower oxygen consumption), higher compliance and lower pressure, it is possible that similar pathophysiological pathways may have different effects on different parts of the heart [19] and the RV dysfunction may appear earlier than in other structures.…”

Substance P/neurokinin1 receptor is associated with the expression of cardiac stem/pluripotency-associated genes in diabetic right and left atria

“…Our previous studies have noted the local activation of c-Kit + cells by SP/NK1R signaling in RA in heart damage 10 . According to a recent study that constructed a rat model of right heart disease (RHD), RA can play an important role in AF maintenance with RA re-entrant activity caused by atrial fibrosis and conduction abnormalities [6][7][8][13][14][15] . To determine whether SP/NK1R affects CSC-related gene expression in LA and RA of LETO and OLETF groups, we selected well-studied genes of cardiac transcription factors and stem cell markers.…”

“…DM can directly affect LV mass, hypertrophy, remodeling, and function 4,5 . Recently, several studies have recognized relationships between DM and the atria [6][7][8] . For example, one study compared the structure and function of the right atrium (RA) of individuals with normal glucose metabolism, prediabetes, and diabetes.…”

“…For example, one study compared the structure and function of the right atrium (RA) of individuals with normal glucose metabolism, prediabetes, and diabetes. Using the Maastricht Study, an observational prospective population-based cohort study, two-dimensional and tissue Doppler echocardiography, and multiple linear regression analyses, the researchers found (pre)diabetes to be associated with structural RA and right ventricle (RV) changes, as well as impaired RV systolic and diastolic function 6 .…”

Komentár k ESC/EASD 2019 Odporúčaniam pre diabetes, prediabetes a kardiovaskulárne ochorenia

“…Prediabetes bol spojený so štrukturálnymi zmenami PP a PK a so zhoršenou systolickou a diastolickou funkciou PK nezávisle od iných KV rizikových faktorov. To naznačuje, že prediabetes ovplyvňuje štruktúru a funkciu PP a PK v dôsledku priameho postihnutia myokardu (25).…”