Disturbed Glucose Metabolism and Left Ventricular Geometry in the General Population

Schmitt, Volker H.; Billaudelle, Anna-Maria; Schulz, Andreas; Keller, Karsten; Hahad, Omar; Tröbs, Sven-Oliver; Koeck, Thomas; Michal, Matthias; Schuster, Alexander K.; Toenges, Gerrit; Lackner, Karl J.; Prochaska, Jürgen H.; Münzel, Thomas; Wild, Philipp S.

doi:10.3390/jcm10173851

Cited by 13 publications

(18 citation statements)

References 44 publications

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“…Type 1 diabetes was shown to be a substantial risk factor in the setting of PE, with higher risk for shock, stroke, RVD, CPR and in‐hospital death. In this context, studies reported that diabetes affected cardiac structure and function, and this might contribute to higher RVD rate in PE patients with diabetes 9 .…”

Section: Discussionmentioning

confidence: 98%

“…The mortality risk of PE patients is associated with the patient’s clinical condition in the setting of acute PE, including hemodynamic status and acute cardiac adaptations (for example, right ventricular dysfunction [RVD]), pre‐existing comorbidities, method of treatment and adverse events 5 , 6 . Diabetes is known as a relevant cardiovascular risk factor 7 , 8 that has a tremendous impact on various organ systems, including the heart 9 and the coagulation system, inducing a shift from normal hemostasis to a hypercoagulable state with prothrombotic characteristics 10 , 11 , 12 . Various mechanisms have been proposed to explain the prothrombotic state in impaired glucose metabolism, including transcription of coagulation factors caused by hyperglycemia‐induced oxidative stress, loss of the endothelial glycocalyx layer that harbors coagulation factors, direct activation of coagulation factors and decreased fibrinolysis 13 , 14 , 15 , 16 , 17 .…”

Section: Introductionmentioning

confidence: 99%

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Diabetes mellitus and its impact on mortality rate and outcome in pulmonary embolism

Schmitt

Hobohm

Sivanathan

et al. 2021

J of Diabetes Invest

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Aims/Introduction In patients with pulmonary embolism (PE), the impact of diabetes mellitus on patient profile and outcome is not well investigated. Material and Methods The German nationwide inpatient sample of the years 2005–2018 was analyzed. Hospitalized PE patients were stratified for diabetes, and the impact of diabetes on in‐hospital events was investigated. Results Overall, 1,174,196 PE patients (53.8% aged ≥70 years, 53.5% women) and, among these, 219,550 (18.7%) diabetes patients were included. In‐hospital mortality rate amounted to 15.8%, and was higher in diabetes patients than in non‐diabetes patients (19.8% vs 14.8%, P < 0.001). PE patients with diabetes had a higher prevalence of cardiovascular risk factors, comorbidities, right ventricular dysfunction (31.8% vs 27.7%, P < 0.001), prolonged in‐hospital stay (11.0 vs 9.0 days, P < 0.001) and higher rates of adverse in‐hospital events. Remarkably, diabetes was independently associated with increased in‐hospital mortality (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.20–1.23, P < 0.001) when adjusted for age, sex and comorbidities. Within the observation period of 2005–2018, a relevant decrease of in‐hospital mortality in PE patients with diabetes was observed (25.5% to 16.8%). Systemic thrombolysis was more often administered to diabetes patients (OR 1.18, 95% CI 1.01–3.49, P < 0.001), and diabetes was associated with intracerebral (OR 1.19, 95% CI 1.12–1.26, P < 0.001), as well as gastrointestinal bleeding (OR 1.11, 95% CI 1.07–1.15, P < 0.001). Type 1 diabetes mellitus was shown to be a strong risk factor in PE patients for shock, right ventricular dysfunction, cardiopulmonary resuscitation and in‐hospital death (OR 1.75, 95% CI 1.61–1.90, P < 0.001). Conclusions Despite the progress in diabetes treatments, diabetes is still associated with an unfavorable clinical patient profile and higher risk for adverse events, including substantially increased in‐hospital mortality in acute PE.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Diabetes mellitus and its impact on mortality rate and outcome in pulmonary embolism

Schmitt

Hobohm

Sivanathan

et al. 2021

J of Diabetes Invest

Self Cite

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“…T2DM is a risk factor for cardiovascular disease and cardiac hypertrophy [36][37][38][39], although the full picture has not been clearly elucidated. However, a recently published prospective cohort study found that T2DM did not affect the incidence of LVH and that concomitant risks, such as hypertension and obesity, have a greater impact on the development of LVH in diabetes patients [40].…”

Section: Discussionmentioning

confidence: 92%

Association of continuous positive airway pressure therapy on cardiac hypertrophy in patients with sleep apnea comorbid with type 2 diabetes mellitus

et al. 2023

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Previous reports indicated the therapeutic effect of chronic continuous positive airway pressure (CPAP) therapy on cardiac hypertrophy due to sleep apnea syndrome. However, little is known for cases involving diabetic complications. This retrospective observational study examined the effects of CPAP therapy on left ventricular hypertrophy (LVH) in patients with obstructive sleep apnea syndrome (OSAS) and type 2 diabetes mellitus (T2DM). For all cases, the observation period was 3 years from the time when the patient was introduced to CPAP therapy. Overall, 123 patients were divided into a good CPAP group (CPAP ≥4 h/day, n = 63) and non-adherence group (CPAP <4 h/day, n = 60). The mean CPAP usage times were 5.58 ± 1.23 and 1.03 ± 1.17 h/day in the good CPAP and non-adherence groups, respectively. Regression tendencies of the thickness of the left ventricular posterior (-0.30 ± 1.19 mm) and interventricular septal walls (-0.48 ± 1.22 mm) were observed in the good CPAP group. Hypertrophic tendencies of the left ventricular posterior wall (+0.59 ± 1.44 mm) and interventricular septal wall thickness (+0.59 ± 1.43) were observed in the non-adherence group. Left ventricular posterior wall thickness (odds ratio, (coefficient: -0.254, p = 0.0376) and interventricular septal wall thickness (coefficient: -0.426, p = 0.0006) were more likely to be greater in the non-adherence group than in the good CPAP group. Patients in the non-adherence group with an apnea hypopnea index ≥30 had increased left ventricular posterior wall thickness (coefficient: -0.263, p = 0.0673) and interventricular septal wall thickness (coefficient: -0.450, p = 0.0011). In conclusion, appropriate CPAP therapy is an effective treatment for LVH in patients with T2DM and OSAS, especially for severe cases.

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“…Intensive glycemic control was shown to lead to a reduction in myocardial infarction in adult patients with type 2 diabetes, 49 and a predictive value of disturbed glucose metabolism for left ventricular hypertrophy has been suggested. 50 It is therefore conceivable that improving glycemic control could positively influence left ventricular mass and thereby cardiac health. The majority of diabetic patients in our cohort suffered from CF.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Burden Is High in Pediatric Lung Transplant Recipients

et al. 2022

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Background. Cardiovascular morbidity is common in adults after lung transplantation (LTx) but has not been described for pediatric LTx recipients. Early subclinical cardiovascular damage is reflected by increases in pulse wave velocity (PWV; indicating arteriosclerosis), intima–media thickness (IMT; indicating atherosclerosis), and left ventricular mass index (LVMI; indicating left ventricular hypertrophy). Methods. We annually assessed 47 pediatric LTx recipients in a prospective longitudinal study (144 observations, mean 3.1 visits/patient, range of 1–4 visits, mean follow-up 2.2 y). Results. At inclusion, increased PWV and IMT were detected in 13% and 30%, respectively, and elevated LVMI was detected in 33%. Higher PWV was associated with male sex, longer time since LTx, higher diastolic blood pressure, and lower glomerular filtration rate. Male sex and lower hemoglobin levels were associated with higher IMT, and the presence of diabetes was associated with higher LVMI. Conclusions. Pediatric LTx recipients suffer from a high and sustained burden of subclinical cardiovascular damage. In light of improving long-term outcomes, cardiovascular morbidity needs to be addressed. Our analysis identified classical and nonclassical risk factors to be associated with the measures for cardiovascular damage, which could serve as targets for intervention.

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Disturbed Glucose Metabolism and Left Ventricular Geometry in the General Population

Cited by 13 publications

References 44 publications

Diabetes mellitus and its impact on mortality rate and outcome in pulmonary embolism

Diabetes mellitus and its impact on mortality rate and outcome in pulmonary embolism

Association of continuous positive airway pressure therapy on cardiac hypertrophy in patients with sleep apnea comorbid with type 2 diabetes mellitus

Cardiovascular Burden Is High in Pediatric Lung Transplant Recipients

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