Heart Failure With Preserved Ejection Fraction in Diabetes: Mechanisms and Management

Meagher, Patrick; Adam, Mohamed; Civitarese, Robert; Bugyei-Twum, Antoinette; Connelly, Kim A.

doi:10.1016/j.cjca.2018.02.026

Cited by 59 publications

(58 citation statements)

References 129 publications

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“…Diabetes mellitus is a chief cause of heart failure, either secondary to CAD or secondary to diabetic cardiomyopathy [ 33 ]. In general, insulin-dependent diabetic patients have more comorbidities than non-insulin dependent diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of type 2 diabetes mellitus on short- and long-term mortality after coronary artery bypass surgery

Kogan

Ram

Levin

et al. 2018

Cardiovasc Diabetol

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BackgroundType 2 diabetes mellitus (DM) is a frequent co-morbidity among patients undergoing coronary artery bypass grafting (CABG) surgery. The aim of this study was to evaluate the impact of DM on the early- and long-term outcomes of patients who underwent isolated CABG.MethodsWe performed an observational cohort study in a large tertiary medical center over a period of 11 years. All data from patients who had undergone isolated CABG surgery between 2004 and 2014 were obtained from our departmental database. The study population included 2766 patients who were divided into two groups: Group I (1553 non-diabetic patients), and Group II (1213 patients suffering from type 2 DM). Group II patients were then divided into two subgroups: subgroup IIA (981 patients treated with oral antihyperglycemic medications) and subgroup IIB (232 insulin-treated patients with or without additional oral antihyperglycemic drugs). In-hospital, 1-, 3-, 5- and 10-year mortality outcome variables were evaluated. Mean follow-up was 97 ± 41 months.ResultsIn-hospital mortality was similar between Group I and Group II patients (1.87% vs. 2.31%, p = 0.422) and between the subgroups IIA and IIB (2.14% vs. 3.02%, p = 0.464). Long-term mortality (1, 3, 5 and 10 years) was higher in Group II (DM type 2) compared with Group I (non-diabetic patients) (5.3% vs. 3.6%, p = 0.038; 9.3% vs. 5.6%, p < 0.001; 15.3% vs. 9.3%, p < 0.001 and 47.3% vs. 29.6% p < 0.001). Kaplan–Meier analysis demonstrated that all-cause mortality was higher in Group II compared with Group I (p < 0.001) and in subgroup IIB compared with subgroup IIA (p = 0.001). Multivariable analysis showed that DM increased the mortality hazard by twofold, and among diabetic patients, insulin treatment increased the mortality hazard by twofold.ConclusionsDiabetic and non-diabetic patients have similar in-hospital mortality rates. Survival rates of diabetic patients start to deteriorate 3 year after surgery. Type 2 DM is an independent predictor for long-term mortality after isolated CABG surgery. Mortality is even higher when the diabetes treatment strategy included insulin.Electronic supplementary materialThe online version of this article (10.1186/s12933-018-0796-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Impact of type 2 diabetes mellitus on short- and long-term mortality after coronary artery bypass surgery

Kogan

Ram

Levin

et al. 2018

Cardiovasc Diabetol

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“…The underlying causes of HFpEF, including hypertension, type 2 diabetes, and coronary artery disease, first damage the most susceptible longitudinally arranged subendocardial myocardial fibers, which lead to impairment of longitudinal function . A previous study also demonstrated that longitudinal function plays a key role in LV myocardial performance and global function in patients with HF .…”

Section: Discussionmentioning

confidence: 98%

Left ventricular systolic dysfunction potentially contributes to the symptoms in heart failure with preserved ejection fraction

et al. 2019

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Aims Left ventricular diastolic dysfunction (LVDD) is considered a key factor associated with heart failure (HF) symptoms in patients with preserved ejection fraction (HFpEF). However, LV systolic performance, including LV systolic function and synchrony, has not been well characterized in these patients. The aims of this study were to assess to investigate the underlying relationship and differences between subclinical LVDD and HFpEF. Methods Eighty‐six patients with LVDD were recruited (58 with HFpEF and 28 with subclinical LVDD). Systolic left ventricular (LV) longitudinal strain (LS), systolic longitudinal strain rate (LSrS), early diastolic longitudinal strain rate (LSrE), and late diastolic longitudinal strain rate (LSrA) were measured using speckle tracking echocardiography. LV diastolic and systolic dyssynchrony (Te‐SD and Ts‐SD) were calculated. Forty age‐ and sex‐matched healthy individuals were enrolled as a control group. Results LV global LS and LSrS were decreased in patients with HFpEF than in normal controls and subclinical LVDD patients (P < .05). Te‐SD and Ts‐SD were significantly more prolonged in subclinical LVDD and HFpEF patients than in the control group (P < .05). Reduced LS was associated with HF symptoms in LVDD patients, and a cutoff value of −18% for LS could differentiate HFpEF from subclinical LVDD with 73% sensitivity and 69% specificity. Conclusion LV systolic function and mechanical dyssynchrony were impaired in HFpEF patients. Deteriorated LV longitudinal systolic function was likely correlated with the symptoms of HFpEF.

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“…Diabetes mellitus is one of the major causes of heart failure in patients with reduced ejection fraction [24], and even in cases in which ejection fraction is preserved [25, 26]. In general, insulin-treated DM patients have more co-morbidities than non insulin-treated DM patients [5, 27, 28] and are prone to more revascularization procedures [16, 29].…”

Section: Discussionmentioning

confidence: 99%

Type 2 diabetes mellitus increases long-term mortality risk after isolated surgical aortic valve replacement

Ram

Kogan

Levin

et al. 2019

Cardiovasc Diabetol

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BackgroundDiabetes mellitus (DM) adversely affects morbidity and mortality for major atherosclerosis-related cardiovascular diseases and is associated with increased risk for the development of aortic stenosis. Clinical data regarding the impact of DM on outcomes of patients undergoing aortic valve replacement (AVR) have revealed inconsistent results. The aim of the current study was to investigate and compare the impact of type 2 DM on short-, intermediate- and long-term mortality between DM and non-DM patients who undergo isolated AVR.MethodsWe performed an observational study in a large tertiary medical center over a 14-year period (2004–2018), which included all patients who had undergone isolated AVR surgery for the first time. Of the 1053 study patients, 346 patients (33%) had type 2 DM (DM group) and were compared with non-DM (non-DM group) patients (67%). Short-term (in-hospital), intermediate (1- and 3-years), and late (5- and 10-years) mortality were evaluated. Mean follow-up of was 69 ± 43 months.ResultsShort-term (in-hospital) mortality was similar between the DM compared with the non-DM group: 3.5% and 2.5% (p = 0.517). Intermediate-term mortality (1- and 3-year) was higher in the DM group compared with the non-DM group, but did not reach statistical significance: 8.1% vs. 5.7% (p = 0.169) and 12.1% vs. 8.3% (p = 0.064) respectively. Long-term (5- and 10-year) mortality was significantly higher in the DM group, compared to the non-DM group: 19.4% vs. 12.9% (p = 0.007) and 30.3% vs. 23.5% (p = 0.020) respectively. Among the 346 DM patients, 55 (16%) were treated with insulin and 291 (84%) with oral antiglycemic medication only. Overall in-hospital mortality among insulin-treated DM patients was 7.3% compared with 2.7% among non insulin-treated DM patients (p = 0.201). Long-term mortality was higher in the subgroup of insulin-treated DM patients compared with the subgroup of non-insulin treated DM patients with an overall mortality rate of 36.4% vs. 29.2% (p = 0.039). Furthermore, predictors for late mortality included DM (HR 1.39 CI 1.03–1.86, p = 0.031) and insulin treatment (HR 1.76 CI 1.05–2.94, p = 0.033), as demonstrated after adjustment for confounders by multivariable analysis.ConclusionsType 2 DM is an independent predictor for long-term mortality after isolated AVR surgery.

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Heart Failure With Preserved Ejection Fraction in Diabetes: Mechanisms and Management

Cited by 59 publications

References 129 publications

Impact of type 2 diabetes mellitus on short- and long-term mortality after coronary artery bypass surgery

Impact of type 2 diabetes mellitus on short- and long-term mortality after coronary artery bypass surgery

Left ventricular systolic dysfunction potentially contributes to the symptoms in heart failure with preserved ejection fraction

Type 2 diabetes mellitus increases long-term mortality risk after isolated surgical aortic valve replacement

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