Glucose dysregulation and subclinical cardiac dysfunction in older adults: The Cardiovascular Health Study

Garg, Parveen K.; Biggs, Mary L.; Kizer, Jorge R.; Shah, Sanjiv J.; Psaty, Bruce M.; Carnethon, Mercedes R.; Gottdiener, John S.; Siscovick, David S.; Mukamal, Kenneth J.

doi:10.1186/s12933-022-01547-z

Cited by 3 publications

(1 citation statement)

References 45 publications

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“…To the best of our knowledge, our study was the first to use strain analyses derived from MRI feature tracking to explore the effect of insulin use on changes in LV mechanics. In a CHS cohort study, Garg et al observed that higher insulin secretion was associated with worse LV longitudinal systolic function in an older population with prediabetes and diabetes [ 19 ]. In contrast, with regard to HFrEF comorbid with T2DM, data from this study displayed worse longitudinal and circumferential systolic strain values in individuals on insulin than in those not on insulin.…”

Section: Discussionmentioning

confidence: 99%

Association of insulin use with LV remodeling and clinical outcomes in diabetic patients with heart failure and reduced ejection fraction: assessed by cardiac MRI

Shi

Zhang

et al. 2023

Cardiovasc Diabetol

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Background Insulin is commonly used in type 2 diabetes mellitus (T2DM) to achieve glycemic control. However, recent evidence showed that insulin use is associated with poor outcomes in the context of heart failure (HF). Since heart failure with reduced ejection fraction (HFrEF) accounts for approximately 50% of cases in the general HF population, we aimed to evaluate the effect of insulin treatment on left ventricular (LV) remodeling and contractility abnormalities in a HFrEF cohort and assess whether insulin was a predictor of adverse outcomes in this entity. Methods A total of 377 HFrEF patients who underwent cardiac MRI were included and divided according to diabetes status and the need for insulin treatment. LV structural and functional indices, as well as systolic strains, were measured. The determinants of impaired myocardial strains were assessed using linear regression analysis. The associated endpoints were determined using a multivariable Cox proportional hazards model. Results T2DM patients on insulin displayed a higher indexed LV end-diastolic volume and LV mass than those with T2DM not on insulin or those without T2DM, despite similar LV ejection fractions, accompanied by a higher three-dimensional spherical index (P < 0.01). Worse longitudinal and circumferential peak systolic strain was shown to occur in T2DM patients on insulin (P < 0.01). Insulin treatment was independently associated with impaired magnitudes of systolic strain. The median follow-up duration was 32.4 months (IQR, 15.6–43.2 months). Insulin treatment remained consistently associated with poor outcomes after adjustment for established confounders, with an adjusted hazard ratio of 3.11; (95% CI, 1.45–6.87; P = 0.009) in the overall cohort and 2.16 (95% CI, 1.08–4.59; P = 0.030) in the diabetes cohort. Conclusions Insulin may further lead to adverse LV remodeling and contractile dysfunction in the context of HFrEF with T2DM. Considerable care should be taken when treating HFrEF patients with insulin.

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Section: Discussionmentioning

confidence: 99%

Association of insulin use with LV remodeling and clinical outcomes in diabetic patients with heart failure and reduced ejection fraction: assessed by cardiac MRI

Shi

Zhang

et al. 2023

Cardiovasc Diabetol

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Association of Pulmonary Transit Time and Pulmonary Blood Volume From First‐Pass Perfusion Cardiac MRI With Diastolic Dysfunction and Left Ventricle Deformation in Restrictive Cardiomyopathy

Gao,

Min,

Jiang

et al. 2024

Magnetic Resonance Imaging

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BackgroundPatients with restrictive cardiomyopathy (RCM) have impaired diastolic filling and hemodynamic congestion. Pulmonary transit time (PTT) and pulmonary blood volume index (PBVi) reflect the hemodynamic status, but the relationship with left ventricle (LV) dysfunction remains unclear.PurposeTo evaluate the PTT and PBVi in RCM patients, the association with diastolic dysfunction and LV deformation, and the effects on the occurrence of major adverse cardiac events (MACE) in RCM patients.Study TypeRetrospective.Population137 RCM patients (88 men, age 58.80 ± 10.83 years) and 68 age‐ and sex‐matched controls (46 men, age 57.00 ± 8.59 years).Field Strength/Sequence3.0T/Balanced steady‐state free precession sequence, recovery prepared echo‐planar imaging sequence, and phase‐sensitive inversion recovery sequence.AssessmentThe LV function and peak strain (PS) parameters were measured. The PTT was calculated and corrected by heart rate (PTTc). The PBVi was calculated as the product of PTTc and RV stroke volume index.Statistical TestsChi‐squared test, student's t‐test, Mann–Whitney U test, Pearson's or Spearman's correlation, multivariate linear regression, Kaplan–Meier survival analysis, and Cox regression models analysis. A P‐value <0.05 was considered statistically significant.ResultsThe PTTc showed a significant correlation with the E/A ratio (r = 0.282), and PBVi showed a significant correlation with the E/e′ ratio, E/A ratio, and diastolic dysfunction stage (r = 0.222, 0.320, and 0.270). PTTc showed an independent association with LVEF, LV circumferential PS, and LV longitudinal PS (β = 0.472, 0.299, and 0.328). In Kaplan–Meier analysis, higher PTTc and PBVi were significantly associated with MACE. In multivariable Cox regression analysis, PTTc was a significantly independent predictor of the MACE in combination with both cardiac MRI functional and tissue parameters (hazard ratio: 1.23/1.32, 95% confidence interval: 1.10–1.42/1.20–1.46).Data ConclusionPTTc and PBVi are associated with diastolic dysfunction and deteriorated LV deformation, and PTTc independently predicts MACE in patients with RCM.Level of Evidence3Technical EfficacyStage 2

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Association of Thyroid Dysfunction in Individuals ≥ 65 Years of Age With Subclinical Cardiac Abnormalities

Barasch,

Gottdiener,

Buzkova

et al. 2024

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context The relationship between thyroid dysfunction and measures of myocardial disease in older individuals remains to be defined. Objective To evaluate the impact of thyroid dysfunction on structure and function of the left-heart chambers and blood markers of cardiac disease. Design Cross-sectional analysis. Setting The Cardiovascular Health Study, a community-based cohort of older individuals recruited from four urban areas in the United States. Patients Of 3163 participants studied, 2477 were euthyroid, 465 had subclinical hypothyroidism (SCH), 47 overt hypothyroidism (OH), 45 endogenous (endo) subclinical hyperthyroidism (endo-SCT), and 129 had exogenous (exo) SCT due to thyroid hormone supplementation. Interventions Clinical evaluation, blood sampling and biomarker measurement, 2-dimensional and speckle-tracking echocardiography. Main outcome measure(s) Left heart myocardial deformation, circulating biomarkers of diastolic overload (NT-proBNP), fibrosis (sST2, gal-3), and cardiomyocyte injury (hs-cTnT). Results SCH was associated with higher NT-proBNP (beta = 0.17, p = 0.004), whereas OH was associated with higher hs-cTnT (beta = 0.29, p = 0.005). There were also suggestive associations of SCH with higher sST2, as well as endo-SCT with higher gal-3 and lower (worse) left atrial reservoir strain. Left ventricular longitudinal strain and end-diastolic strain rate did not differ significantly from euthyroid participants in SCH, OH, or exo-SCT. Conclusions In this free-living elderly cohort, subclinical and overt hypothyroidism were associated with abnormalities of blood biomarkers consistent with diastolic overload and myocardial necrosis respectively, whereas subclinical hyperthyroidism tended to be associated with myocardial fibrosis and decreased left atrial strain. Our findings could represent stage B heart failure and illuminate distinct aspects of the pathobiology of heart disease related to thyroid gland dysfunction with potential clinical implications.

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Glucose dysregulation and subclinical cardiac dysfunction in older adults: The Cardiovascular Health Study

Cited by 3 publications

References 45 publications

Association of insulin use with LV remodeling and clinical outcomes in diabetic patients with heart failure and reduced ejection fraction: assessed by cardiac MRI

Association of insulin use with LV remodeling and clinical outcomes in diabetic patients with heart failure and reduced ejection fraction: assessed by cardiac MRI

Association of Pulmonary Transit Time and Pulmonary Blood Volume From First‐Pass Perfusion Cardiac MRI With Diastolic Dysfunction and Left Ventricle Deformation in Restrictive Cardiomyopathy

Association of Thyroid Dysfunction in Individuals ≥ 65 Years of Age With Subclinical Cardiac Abnormalities

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