Role of Diabetes Mellitus in Heart Failure With Preserved Ejection Fraction: A Review Article

Mgbemena, Okechukwu; Zhang, Yixin; Velarde, Gladys

doi:10.7759/cureus.19398

Cited by 8 publications

(5 citation statements)

References 55 publications

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“…Unlike HF with reduced ejection fraction (HFrEF), HFpEF has distinct clinical phenotypes, and the obese-diabetic phenotype is the most often encountered phenotype in clinical practice. 38,39 In the Phosphodiesterase-5 inhibition to improve clinical status and Exercise capacity in Diastolic HF (RELAX) trial, 40 body mass index (BMI) was 37.1 vs. 30.7 kg/m 2 in patients with and without T2DM. In this category of patients, LV remodelling was more relevant and associated with reduced ventricular compliance with increased systemic and pulmonary venous pressures and congestion despite preserved systolic function.…”

Section: Clinical Characteristicsmentioning

confidence: 99%

“…There is a high prevalence of T2DM in patients with HFpEF, and the presence of T2DM has been shown to increase mortality of patients with HFpEF by 30–50% even after adjustment for age, gender, hospital factors, and other patient characteristics. Unlike HF with reduced ejection fraction (HFrEF), HFpEF has distinct clinical phenotypes, and the obese–diabetic phenotype is the most often encountered phenotype in clinical practice 38,39 …”

Section: Background: Role Of Obesity In Heart Failure With Preserved ...mentioning

confidence: 99%

“…Unlike HF with reduced ejection fraction (HFrEF), HFpEF has distinct clinical phenotypes, and the obese–diabetic phenotype is the most often encountered phenotype in clinical practice. 38 , 39 …”

Section: Background: Role Of Obesity In Heart Failure With Preserved ...mentioning

confidence: 99%

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Obesity, heart failure with preserved ejection fraction, and the role of glucagon‐like peptide‐1 receptor agonists

Cimino,

Vaduganathan,

Lombardi

et al. 2023

ESC Heart Failure

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Heart failure with preserved ejection fraction (HFpEF) has a high prevalence, affecting more than 50% of patients with heart failure. HFpEF is associated with multiple comorbidities, and obesity is one of the most common. A distinct phenotype has been proposed for obese patients with HFpEF. Recent data show the beneficial role of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) for weight loss in diabetic and non‐diabetic patients with obesity or overweight when given as adjunctive therapy to diet and exercise. The mechanisms of action are related to paracrine and endocrine signalling pathways within the gastrointestinal tract, pancreas, and central nervous system that delay gastric emptying, decrease appetite, augment pancreatic beta‐cell insulin secretion, and suppress pancreatic glucagon release. These drugs are therefore potentially indicated for treatment of patients with HFpEF and obesity or overweight. Efficacy and safety need to be shown by clinical trials with a first one, Semaglutide Treatment Effect in People with obesity and heart failure with preserved ejection fraction (STEP HFpEF), recently concluded. The aim of the present review is to provide the pathophysiological and pharmacological rationale for GLP‐1 RA administration to obese patients with HFpEF.

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Section: Clinical Characteristicsmentioning

confidence: 99%

Section: Background: Role Of Obesity In Heart Failure With Preserved ...mentioning

confidence: 99%

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Obesity, heart failure with preserved ejection fraction, and the role of glucagon‐like peptide‐1 receptor agonists

Cimino,

Vaduganathan,

Lombardi

et al. 2023

ESC Heart Failure

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show abstract

“…Although diabetes appears to have a well-established role in HFpEF development, less is known regarding its impact on established HFpEF. Notably, while metformin has been reported to improve HFpEF outcomes (Wang et al, 2021), none of the other anti-diabetes medications have been shown to confer survival benefits (Mgbemena et al, 2021) except for SGLT2 inhibitors (whose cardioprotective effect is likely independent of its anti-glycemic function (Anker et al, 2021;Ebell, 2022)). Thus, these observations support diabetes as a risk factor for HFpEF development but challenge the notion that diabetes continues to play an active role in established HFpEF.…”

Section: Obesity and Diabetesmentioning

confidence: 99%

Modeling heart failure with preserved ejection fraction in rodents: Where do we stand?

Chou

Chin

2022

Front. Drug. Discov.

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Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by signs and symptoms of HF in the presence of a normal left ventricular systolic function. Over the past decade, HFpEF has become increasingly prevalent, accounting for greater than 50% of all clinical HF presentations. HFpEF is a complex disease with heterogeneous clinical presentations and multiple non-cardiac comorbidities, which frequently co-exist and contribute to its pathophysiology. To date, only a handful of therapies have been proven to improve, albeit marginally, the outcomes in HFpEF. The development of effective therapeutic agents is in part hampered by the lack of animal models that adequately recapitulate human HFpEF. Although numerous pre-clinical models developed over the years have been labeled as “HFpEF” specific, there has not been a consensus on the appropriate standards for pre-clinical HFpEF models. Thus, the extent to which they truly mirror human HFpEF cannot be systematically validated. Recently, a new algorithm (H2FPEF) was developed to standardize the clinical diagnosis of HFpEF. In this review, with the aid of the clinical H2FPEF scoring system, we evaluate the clinical applicability and translational values of various murine models of HFpEF.

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“…Type 2 diabetes mellitus (T2DM) is one of the most frequently seen risk factors and comorbidities in patients with congestive heart failure (CHF) ( 11 , 12 ), and it adversely affects outcomes in these patients ( 13 , 14 ). The impact of T2DM on different phenotypic presentations of HF, especially in patients with HF and preserved ejection fraction (HFpEF), remains unclear ( 15 , 16 ). Impaired energy metabolism and muscle fiber-type switches ( 17 , 18 ) found in T2DM, similar to what is seen in CHF, have been previously shown.…”

Section: Introductionmentioning

confidence: 99%

Diabetes Is the Strongest Predictor of Limited Exercise Capacity in Chronic Heart Failure and Preserved Ejection Fraction (HFpEF)

Berisha-Muharremi

Henein

Dini

et al. 2022

Front. Cardiovasc. Med.

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Background and AimType 2 diabetes mellitus (T2DM) is a known risk factor in patients with heart failure (HF), but its impact on phenotypic presentations remains unclear. This study aimed to prospectively examine the relationship between T2DM and functional exercise capacity, assessed by the 6-min walk test (6-MWT) in chronic HF.MethodsWe studied 344 chronic patients with HF (mean age 61 ± 10 years, 54% female) in whom clinical, biochemical, and anthropometric data were available and all patients underwent an echo-Doppler study and a 6-MWT on the same day. The 6-MWT distance divided the cohort into; Group I: those who managed ≤ 300 m and Group II: those who managed >300 m. Additionally, left ventricular (LV) ejection fraction (EF), estimated using the modified Simpson's method, classified patients into HF with preserved EF (HFpEF) and HF with reduced EF (HFrEF).ResultsThe results showed that 111/344 (32%) patients had T2DM, who had a higher prevalence of arterial hypertension (p = 0.004), higher waist/hips ratio (p = 0.041), higher creatinine (p = 0.008) and urea (p = 0.003), lower hemoglobin (p = 0.001), and they achieved shorter 6-MWT distance (p < 0.001) compared with those with no T2DM. Patients with limited exercise (<300 m) had higher prevalence of T2DM (p < 0.001), arterial hypertension (p = 0.004), and atrial fibrillation (p = 0.001), higher waist/hips ratio (p = 0.041), higher glucose level (p < 0.001), lower hemoglobin (p < 0.001), larger left atrium (LA) (p = 0.002), lower lateral mitral annular plane systolic excursion (MAPSE) (p = 0.032), septal MAPSE (p < 0.001), and tricuspid annular plane systolic excursion (TAPSE) (p < 0.001), compared with those performing >300 m. In the cohort as a whole, multivariate analysis, T2DM (p < 0.001), low hemoglobin (p = 0.008), atrial fibrillation (p = 0.014), and reduced septal MAPSE (p = 0.021) independently predicted the limited 6-MWT distance.In patients with HFpEF, diabetes [6.083 (2.613–14.160), p < 0.001], atrial fibrillation [6.092 (1.769–20.979), p = 0.002], and septal MAPSE [0.063 (0.027–0.184), p = 0.002], independently predicted the reduced 6-MWT, whereas hemoglobin [0.786 (0.624–0.998), p = 0.049] and TAPSE [0.462 (0.214–0.988), p = 0.041] predicted it in patients with HFrEF.ConclusionPredictors of exercise intolerance in patients with chronic HF differ according to LV systolic function, demonstrated as EF. T2DM seems the most powerful predictor of limited exercise capacity in patients with HFpEF.

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Role of Diabetes Mellitus in Heart Failure With Preserved Ejection Fraction: A Review Article

Cited by 8 publications

References 55 publications

Obesity, heart failure with preserved ejection fraction, and the role of glucagon‐like peptide‐1 receptor agonists

Obesity, heart failure with preserved ejection fraction, and the role of glucagon‐like peptide‐1 receptor agonists

Modeling heart failure with preserved ejection fraction in rodents: Where do we stand?

Diabetes Is the Strongest Predictor of Limited Exercise Capacity in Chronic Heart Failure and Preserved Ejection Fraction (HFpEF)

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