Diabetic retinopathy is associated with diastolic dysfunction in type 2 diabetic patients with non-ischemic dilated cardiomyopathy

Younghae, Chung; Park, Sejun; Moon, Ka Young; Choi, Seoyoung Annie; Lim, Hong Seok; Park, Sung Wook; Kim, Jeong Hun; Lee, Kihwang

doi:10.1186/s12933-017-0566-y

Cited by 8 publications

(8 citation statements)

References 38 publications

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“…Echocardiographic studies have shown that T2D is associated with abnormalities of diastolic function independent of the presence of coronary artery disease . In addition, the presence of MiVD in patients with T2D also seems to be associated with the presence of diastolic dysfunction . It is possible that MiVD plays a role in the pathophysiology of incident HFpEF but, perhaps more importantly, that MiVD is a risk factor for development of HFpEF.…”

Section: Discussionmentioning

confidence: 99%

Microvascular disease and heart failure with reduced and preserved ejection fraction in type 2 diabetes

et al. 2020

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Aims Identification of patients with type 2 diabetes (T2D) at increased risk of incident heart failure (HF) beyond traditional risk factors such as prior myocardial infarction (MI) might allow selection of patients who would benefit from preventative treatment. Microvascular disease (MiVD) is thought to play a pathophysiological role in the development of HF in T2D; however, its association with new-onset HF with reduced or preserved ejection fraction has not been specifically defined. Methods and results Patients in the Genetics of Diabetes Audit and Research Tayside Scotland study were linked to echocardiography, prescriptions, and clinical outcomes. In total, 9141 patients with T2D were identified for analysis. Clinical variables and the presence of retinopathy, nephropathy, and neuropathy were assessed. Cumulative incidence was calculated for the association of both individual and the total number of MiVD states and incident HF. Median follow-up was 9.3 years. In total, there were 900 HF events. The presence of any MiVD was independently associated with both HF with reduced ejection fraction (hazard ratio 1.40; 95% confidence interval 1.11-1.76, P = 0.004) and HF with preserved ejection fraction (hazard ratio 1.38; 95% confidence interval 1.10-1.72, P = 0.005), with a stepwise association between the number of MiVD states and risk of incident HF (P for trend <0.001). Similar associations were found in sensitivity analyses limited to patients without a prior MI, and using competing risks analysis. Conclusions Individuals with T2D and with MiVD are at risk of incident HF independent of a history of prior HF or MI. Patients with MiVD could benefit from screening for HF and individualized therapy with treatments that lower HF risk.

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Section: Discussionmentioning

confidence: 99%

Microvascular disease and heart failure with reduced and preserved ejection fraction in type 2 diabetes

et al. 2020

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“…When prescribing a secondary oral hypoglycemic agent, its effects on vascular complications are an important consideration. We recently reported the association of DR with diastolic dysfunction in type 2 diabetic patients with cardiomyopathy [36], so efforts to prevent the progression of DR might also protect cardiac function. DPP4 inhibitors can protect against DR [16, 37], but their effect on DR remains controversial because they may aggravate vascular leakage [17].…”

Section: Discussionmentioning

confidence: 99%

Potent Oral Hypoglycemic Agents for Microvascular Complication: Sodium-Glucose Cotransporter 2 Inhibitors for Diabetic Retinopathy

Cho¹,

Park

Han

et al. 2018

Journal of Diabetes Research

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The purpose of this study was to investigate the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on the progression of diabetic retinopathy (DR) in patients with type 2 diabetes. The medical records of 21 type 2 diabetic patients who used a SGLT2i and 71 patients with sulfonylurea (control) were reviewed retrospectively. The severity of DR was assessed using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Fewer patients who used a SGLT2i than control patients with sulfonylurea showed progression of DR based on ETDRS scale (44% versus 14%, P = 0.014). Moreover, treatment with a SGLT2i was associated with a significantly lower risk of DR progression (P = 0.021), and this effect remained significant after adjusting for the age, duration of diabetes, initial DR grade, and HbA1c level by propensity score matching (P = 0.013). Treatment of type 2 diabetic patients with a SGLT2i slowed the progression of DR compared to sulfonylurea, which is independent of its effect on glycemic control. This study provides a foundation for further evaluation of the effect of SGLT2i on the progression of DR.

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“…Similar findings quoted by Yoo Ri Chung et al, the E/A ratio, E or E/E′ratio, that represent diastolic dysfunction, were impaired in subjects with diabetic retinopathy compared to those without retinopathy. [17] Soichi Kurioka et al concluded that, almost all subjects had asymptomatic LVDD and that the severity of diabetic retinopathy was associated with LVDD in subjects with T2DM. [18] In the present study, diabetic subjects with microalbuminuria had significant lower values of E/A ratio, e', E'sr and high values of A, E/e', E/E'sr and peak TR jet velocity, compared to those without microalbuminuria.…”

Section: Resultsmentioning

confidence: 99%

Relation of Retinopathy and Microalbuminuria With Diastolic Dysfunction in Subjects With Type 2 Diabetes Mellitus

2020

jcr

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Background: Prevalence of heart failure in asymptomatic type 2 DM subjects is increasing. Presence of microvascular complications like retinopathy and microalbuminuria, is under evaluation for predicting cardiovascular complications like heart failure in type 2 DM subjects. Aims and objectives: To study the relation between diabetic retinopathy and microalbuminuria with presence and grades of diastolic dysfunction in type 2 diabetes mellitus (DM) subjects. Materials and methods: This was a cross-sectional, observational study. A total of 62 subjects with type 2 diabetes mellitus (Type-2 DM) were enrolled. Fundoscopy examination for diabetic retinopathy, urine for microalbuminuria and standardized transthoracic echocardiographic (TTE) examination were performed. Left ventricular diastolic dysfunction (LVDD) was labeled if ≥3 of variables were present: "Septal e <7 cm/sec or Lateral e <10 cm/sec, E/e ratio >14, LA volume index >34 mL/m 2 , Peak TR velocity >2.8 m/sec. Results: The peak early trans-mitral filling wave velocity (E) was low in subjects with diabetic retinopathy [40 ± 11.6 cm/s vs 46 ± 9.6cm/s]. Mean of E/A ratio in subjects with diabetic retinopathy group was significantly lower compared to those without retinopathy ('p' < 0.03). The E/e' ratio was significantly higher in subjects with retinopathy (15.7 ± 2.48 vs 13.24 ± 1.88, p<0.02). The subjects with retinopathy and/or microalbuminuria had lower mean E/A ratio, deceleration time (DT), e' and higher E/e' ratio. Total 14(22.58%) subjects had diabetic retinopathy, all had mild non-proliferative diabetic retinopathy (NPDR) and 20(32.26%) subjects had microalbuminuria. Total 28 (45.16%) subjects had diastolic dysfunction [grade I: 24 (85.71%), grade-II: 4 (14.29%)]. Amongst 28 subjects with LVDD, 10(35.71%) had diabetic retinopathy and 15(53.57%) had microalbuminuria. Significant association was present between presence of retinopathy and microalbuminuria with diastolic dysfunction (p=0.024 and 0.001, respectively). Conclusion: Prevalence of LVDD in asymptomatic type 2 diabetes mellitus subject was 45.16%. Present study highlighted strong association between presence of diabetic retinopathy and microalbuminuria with LV diastolic dysfunction in subjects with type 2 diabetes mellitus.

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Diabetic retinopathy is associated with diastolic dysfunction in type 2 diabetic patients with non-ischemic dilated cardiomyopathy

Cited by 8 publications

References 38 publications

Microvascular disease and heart failure with reduced and preserved ejection fraction in type 2 diabetes

Microvascular disease and heart failure with reduced and preserved ejection fraction in type 2 diabetes

Potent Oral Hypoglycemic Agents for Microvascular Complication: Sodium-Glucose Cotransporter 2 Inhibitors for Diabetic Retinopathy

Relation of Retinopathy and Microalbuminuria With Diastolic Dysfunction in Subjects With Type 2 Diabetes Mellitus

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