Clinical Implications of Echocardiographic Phenotypes of Patients With Diabetes Mellitus

Ernande, Laura; Audureau, Étienne; Jellis, Christine; Bergerot, Cyrille; Hénégar, Corneliu; Sawaki, Daigo; Czibik, Gabor; Volpi, Chiara Costanza; Canouï‐Poitrine, Florence; Thibault, Hélène; Ternacle, Julien; Moulin, Philippe; Marwick, Thomas H.; Dérumeaux, Geneviève

doi:10.1016/j.jacc.2017.07.792

Cited by 115 publications

(98 citation statements)

References 39 publications

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“…Our study supports the hypothesis that in an asymptomatic, low‐intermediate cardiovascular risk population, subclinical LV dysfunction and epicardial coronary atherosclerosis are results of separate pathophysiological mechanisms. In addition, no participant met criteria for both subclinical diastolic and systolic dysfunction, consistent with distinct phenotypes previously noted in diabetic cohorts 17 . While the prevalence of subclinical dysfunction was low, it was not uncommon but no clear association with typical heart failure risk factors was identifiable.…”

Section: Discussionsupporting

confidence: 70%

Independence of coronary artery disease to subclinical left ventricular dysfunction

et al. 2020

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Objective: Epicardial atherosclerosis and heart failure while distinct clinical entities share common pathophysiological features including endothelial dysfunction and inflammation. Presence of subclinical disease could lead to early diagnosis and intervention in the other. The aim of our study was to assess the association between coronary calcium score (CCS), conventional cardiovascular risk factors, and echocardiographic markers of subclinical left ventricular dysfunction (S-LVD). Methods: One hundred and fifty-nine participants aged 40-70 years with intermediate risk of coronary artery disease (5-year risk of 2%-15%) were identified. Computed tomography (CT) CCS and 2-D transthoracic echocardiography were performed. Main outcomes included presence of subclinical left ventricular dysfunction defined by reduced average global longitudinal strain, left atrial volume enlargement, and elevated E/e'. Results: Fifteen participants had evidence of subclinical LV dysfunction (8 with systolic dysfunction and 7 with diastolic dysfunction) and 85 participants had CCS > 0.CCS > 0 was present in 10 participants with S-LVD compared to 75 participants without S-LVD (67% vs 53%, P = .47). There was no significant difference between in mean GLS (19.2 vs 19.5, P = .14), E/e' (7.2 vs 7.5 P = .33) in those without or with coronary artery calcium. Elevated CCS was also not associated with a higher tertiles of indexed LV mass (OR 1.15, P = .49) or index left atrial volume (OR 1.15, P = .49). Conclusions: In an asymptomatic, low-intermediate-risk group, mechanistic processes that lead to atherosclerosis are not directly associated with subclinical LV dysfunction. K E Y W O R D S coronary artery calcification, diastology, familial coronary artery disease, global longitudinal strain | 679 VENKATARAMAN ET Al.Coronary artery calcification (CAC) provides direct evidence of coronary artery disease (CAD) in the asymptomatic stage. Although there is a strong association between CAC and incident HF, only partly mitigated after adjustment for cardiovascular risk factors, 7,8 it seems likely that this reflects the contribution of overt CAD to HF.Previous studies suggesting a link between CAC and LV dysfunction were in patients with very high burdens of CAC (≥400), 9 greater severity of LV dysfunction measured by ejection fraction, 10,11 or high baseline risk, such as those with suspected CAD or known diabetes. 12,13 The role of CAD in the development of SBHF is unclear in the setting of early disease. Thus, we sought to investigate the relationship between CAC and echocardiographic markers of subclinical LV dysfunction in asymptomatic individuals. | ME THODS | Study designThe Coronary Artery calcium score: Use to Guide Management of HerediTary CAD (CAUGHT-CAD) trial (ACTRN 12614001294640, https://www.anzctr.org.au/) is a randomized controlled trial to assess the utility of coronary calcium score (CCS) to guide risk evaluation and statin therapy in asymptomatic, intermediate-risk patients (5-year risk 2%-15%) of age 40-70 years with a family hi...

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Section: Discussionsupporting

confidence: 70%

Independence of coronary artery disease to subclinical left ventricular dysfunction

et al. 2020

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“…DMCMP is imputable to long-standing hyperglycaemia and consequent oxidative stress and manifests itself with different clinical and echocardiographic phenotypes: (a) men with preserved systolic and diastolic function; (b) obese and hypertensive women with diastolic dysfunction; (c) men with left ventricular (LV) hypertrophy and systolic dysfunction. 9,19 Initial subclinical cardiac abnormalities of DMCMP, such as LV fibrosis and increased LV stiffness, might occur independently of diabetes duration and quality of metabolic control and can progress to symptomatic HF. 9,20 In diabetes clinical trials, subjects with HF are poorly represented and therefore the prevalence of HF in diabetes is underestimated, ranging from 19-26%.…”

Section: Cardiomyopathy Due To Diabetes and Hfmentioning

confidence: 99%

Diabetes as a cardiovascular risk factor: An overview of global trends of macro and micro vascular complications

Canto¹,

Ceriello

Rydén

et al. 2019

European Journal of Preventive Cardiology

546

275

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The global prevalence of diabetes is predicted to increase dramatically in the coming decades as the population grows and ages, in parallel with the rising burden of overweight and obesity, in both developed and developing countries. Cardiovascular disease represents the principal cause of death and morbidity among people with diabetes, especially in those with type 2 diabetes mellitus. Adults with diabetes have 2–4 times increased cardiovascular risk compared with adults without diabetes, and the risk rises with worsening glycaemic control. Diabetes has been associated with 75% increase in mortality rate in adults, and cardiovascular disease accounts for a large part of the excess mortality. Diabetes-related macrovascular and microvascular complications, including coronary heart disease, cerebrovascular disease, heart failure, peripheral vascular disease, chronic renal disease, diabetic retinopathy and cardiovascular autonomic neuropathy are responsible for the impaired quality of life, disability and premature death associated with diabetes. Given the substantial clinical impact of diabetes as a cardiovascular risk factor, there has been a growing focus on diabetes-related complications. While some population-based studies suggest that the epidemiology of such complications is changing and that rates of all-cause and cardiovascular mortality among individuals with diabetes are decreasing in high-income countries, the economic and social burden of diabetes is expected to rise due to changing demographics and lifestyle especially in middle- and low-income countries. In this review we outline data from population-based studies on recent and long-term trends in diabetes-related complications.

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“…The component Astragalus can tonify the middle-Jiao and Qi and disperse the essence to the lung. Meanwhile, Ophiopogon japonicus, dried Rehmannia root, and Salvia miltiorrhiza help activate and nourish the blood and thus replenish and enhance yin [7]. Schisandra chinensis nourishes and astringes yin and engenders the liquid.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of invigorating qi, nourishing yin, and promoting blood circulation in treatment of type 2 diabetes mellitus

Zhang¹

2018

biomedicalresearch

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Objective: This study aims to investigate the clinical efficacy of invigorating qi, nourishing yin, and promoting blood circulation in the treatment of type 2 diabetes mellitus. Methods: Sixty-six patients with type 2 diabetes mellitus admitted to our hospital from February 2015 to January 2017 were recruited in this study. Odd-even method was used to divide the patients into two groups. Patients in the control group (n=33) were given with conventional treatment for type 2 diabetes mellitus, and those in the observation group (n=33) were administered with a conventional scheme involving invigorating qi, nourishing yin, and promoting blood circulation. The TCM syndrome efficacy and the levels of TC, FBG, and FINS were compared between the two groups. Results: Compared with the control group (72.73%), the observation group showed significantly improved TCM syndrome (96.97%) (P<0.05) and significantly increased levels of TC, FBG, and FINS (P<0.05). Conclusion: Treating patients with type 2 diabetes mellitus by invigorating qi, nourishing yin, and promoting blood circulation can ensure TCM syndrome efficacy and increase the levels of TC, FBG, and FINS levels, thereby improving the treatment outcomes.

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Clinical Implications of Echocardiographic Phenotypes of Patients With Diabetes Mellitus

Abstract: Cluster analysis of echocardiographic variables identified 3 different echocardiographic phenotypes of T2DM patients that were associated with distinct clinical profiles and highlighted the prognostic value of LV remodeling and subclinical dysfunction.

Cited by 115 publications

References 39 publications

Independence of coronary artery disease to subclinical left ventricular dysfunction

Independence of coronary artery disease to subclinical left ventricular dysfunction

Diabetes as a cardiovascular risk factor: An overview of global trends of macro and micro vascular complications

Clinical efficacy of invigorating qi, nourishing yin, and promoting blood circulation in treatment of type 2 diabetes mellitus

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