suPAR level is associated with myocardial impairment assessed with advanced echocardiography in patients with type 1 diabetes with normal ejection fraction and without known heart disease or end-stage renal disease

Abstract

Aim Heart disease is a common fatal diabetes-related complication. Early detection of patients at particular risk of heart disease is of prime importance. Soluble urokinase plasminogen activator receptor (suPAR) is a novel biomarker for development of cardiovascular disease. We investigate if suPAR is associated with early myocardial impairment assessed with advanced echocardiographic methods. Methods In an observational study on 318 patients with type 1 diabetes without known heart disease and with normal left ventricular ejection fraction (LVEF) (biplane LVEF >45%), we performed conventional, tissue Doppler and speckle tracking echocardiography, and measured plasma suPAR levels. Associations between myocardial function and suPAR levels were studied in adjusted models including significant covariates. Results Patients were 55±12 years (mean±s.d.) and 160 (50%) males. Median (interquartile range) suPAR was 3.4 (1.7) ng/mL and LVEF was 58±5%. suPAR levels were not associated with LVEF (P=0.11). In adjusted models, higher suPAR levels were independently associated with both impaired systolic function assessed with global longitudinal strain (GLS) and tissue velocity s′, and with impaired diastolic measures a′ and e′/a′ (all P=0.034). In multivariable analysis including cardiovascular risk factors and both systolic and diastolic measures (GLS and e′/a′), both remained independently associated with suPAR levels (P=0.012). Conclusions In patients with type 1 diabetes with normal LVEF and without known heart disease, suPAR is associated with early systolic and diastolic myocardial impairment. Our study implies that both suPAR and advanced echocardiography are useful diagnostic tools for identifying patients with diabetes at risk of future clinical heart disease, suited for intensified medical therapy.

Value of soluble Urokinase plasminogen activator receptor over age as a biomarker of impaired myocardial relaxation

“…By demonstrating that suPAR is predictive of impaired myocardial relaxation, an early manifestation diastolic dysfunction commonly associated with ageing, our current study builds on this emerging link between suPAR and diastolic function, particularly as assessed by echocardiography. Diabetes mellitus was not a significant predictor of myocardial function in our study, in contrast to Theilade et al’s study [ 12 ] that was prespecified to study suPAR among diabetic patients. Further, we had acquired echocardiographic images simultaneously with blood sampling at the same study visit, possibly eliminating potential clinical events intervening between assessment of myocardial function and blood sampling that may inaccurately depict the relationship between suPAR and myocardial function.…”

“…Further, we had acquired echocardiographic images simultaneously with blood sampling at the same study visit, possibly eliminating potential clinical events intervening between assessment of myocardial function and blood sampling that may inaccurately depict the relationship between suPAR and myocardial function. In contrast to Theilade’s study [ 12 ] that had a median interval of 116 days between echocardiography acquisition and blood sampling, the observed value of suPAR in predicting myocardial function in our study is unlikely influenced by other unknown systemic disease processes. This is especially pertinent in studies that evaluate suPAR as a potential biomarker of disease, because suPAR may represent general states of ill-health.…”

“…In the area of early diastolic dysfunction, hardly any study has looked at the association between suPAR and subclinical myocardial dysfunction. One recent study investigated associations between suPAR and subclinical diastolic dysfunction among a cohort wholly composed of Type 1 diabetic patients [ 12 ]. In their study, suPAR was associated with early systolic and diastolic myocardial impairment, measured via echocardiographic techniques [ 12 ].…”

“…One recent study investigated associations between suPAR and subclinical diastolic dysfunction among a cohort wholly composed of Type 1 diabetic patients [ 12 ]. In their study, suPAR was associated with early systolic and diastolic myocardial impairment, measured via echocardiographic techniques [ 12 ]. By demonstrating that suPAR is predictive of impaired myocardial relaxation, an early manifestation diastolic dysfunction commonly associated with ageing, our current study builds on this emerging link between suPAR and diastolic function, particularly as assessed by echocardiography.…”

Association between serum soluble urokinase‐type plasminogen activator receptor and atrial fibrillation

“…Considering that impaired renal function and the presence of microalbuminuria substantially enhance the risk of cardiovascular disorders [11] , [12] , it is thought that suPAR may represent a novel biomarker for various cardiovascular disorders. In fact, suPAR levels may be elevated in patients with coronary artery disease, stroke, and heart failure [13] , [14] , [15] , [16] . We recently reported that suPAR is associated with a low left ventricular ejection fraction (LVEF) and increased plasma levels of brain-type natriuretic peptide (BNP) [17] .…”