In patients with HFpEF, diabetes mellitus was associated with a greater left ventricular mass index (78.1 vs 63.6 g; P=0.0093) and increased arterial stiffness compared to nondiabetic patients.
Observational (n=53)
Does diabetes mellitus worsen ventricular structure, arterial stiffness, and pulsatile hemodynamics in patients with HFpEF?
Diabetes mellitus in HFpEF is associated with significantly worse left ventricular remodeling, increased arterial stiffness, and adverse pulsatile hemodynamics compared to HFpEF without diabetes.
Absolute Event Rate: 78.1% vs 63.6%
p-value: p=0.0093
Background Heterogeneity in the underlying processes that contribute to heart failure with preserved ejection fraction ( HF p EF ) is increasingly recognized. Diabetes mellitus is a frequent comorbidity in HF p EF , but its impact on left ventricular and arterial structure and function in HF p EF is unknown. Methods and Results We assessed the impact of diabetes mellitus on left ventricular cellular and interstitial hypertrophy (assessed with cardiac magnetic resonance imaging, including T1 mapping pregadolinium and postgadolinium administration), arterial stiffness (assessed with arterial tonometry), and pulsatile arterial hemodynamics (assessed with in‐office pressure‐flow analyses and 24‐hour ambulatory monitoring) among 53 subjects with HF p EF (32 diabetic and 21 nondiabetic subjects). Despite few differences in clinical characteristics, diabetic subjects with HFpEF exhibited a markedly greater left ventricular mass index (78.1 95% CI , 70.4–85.9 g versus 63.6 95% CI , 55.8–71.3 g; P =0.0093) and indexed extracellular volume (23.6 95% CI , 21.2–26.1 mL/m 2 versus 16.2 95% CI , 13.1–19.4 mL/m 2 ; P =0.0008). Pronounced aortic stiffening was also observed in the diabetic group (carotid‐femoral pulse wave velocity, 11.86 95% CI , 10.4–13.1 m/s versus 8.8 95% CI , 7.5–10.1 m/s; P =0.0027), with an adverse pulsatile hemodynamic profile characterized by increased oscillatory power (315 95% CI , 258–373 mW versus 190 95% CI , 144–236 mW; P =0.0007), aortic characteristic impedance (0.154 95% CI , 0.124–0.183 mm Hg/mL per second versus 0.096 95% CI , 0.072–0.121 mm Hg/mL per second; P =0.0024), and forward (59.5 95% CI , 52.8–66.1 mm Hg versus 40.1 95% CI , 31.6–48.6 mm Hg; P =0.0010) and backward (19.6 95% CI , 16.2–22.9 mm Hg versus 14.1 95% CI , 10.9–17.3 mm Hg; P =0.0169) wave amplitude. Abnormal pulsatile hemodynamics were also evident in 24‐hour ambulatory monitoring, despite the absence of significant differences in 24‐hour systolic blood pressure between the groups. Conclusions Diabetes mellitus is a key determinant of left ventricular remodeling, arterial stiffness, adverse pulsatile hemodynamics, and ventricular‐arterial interactions in HF p EF . Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifier: NCT 01516346.
Chirinos et al. (Fri,) conducted a observational in Heart failure with preserved ejection fraction (HFpEF) (n=53). Diabetes mellitus vs. Nondiabetic subjects was evaluated on Left ventricular mass index (p=0.0093). In patients with HFpEF, diabetes mellitus was associated with a greater left ventricular mass index (78.1 vs 63.6 g; P=0.0093) and increased arterial stiffness compared to nondiabetic patients.