What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with reduced ejection fraction (HFrEF) and hypertension (n=249). Intervention: Diabetes mellitus vs. Hypertensive HFrEF without diabetes mellitus. Primary outcome: Right ventricular global longitudinal strain (RVGLS) (p=<0.001).

October 23, 2024Open Access

Impact of diabetes mellitus on right ventricular dysfunction and ventricular interdependence in hypertensive patients with heart failure with reduced ejection fraction assessed via 3.0 T cardiac MRI

Q: What are the key findings of this study?

In hypertensive patients with heart failure with reduced ejection fraction, comorbid diabetes mellitus was independently associated with significantly worse right ventricular global longitudinal strain compared to those without diabetes (-6.3% vs -8.6%, p<0.001).

Key Result

In hypertensive patients with heart failure with reduced ejection fraction, comorbid diabetes mellitus was independently associated with significantly worse right ventricular global longitudinal strain compared to those without diabetes (-6.3% vs -8.6%, p<0.001).

Study Design

Type

Cohort (n=249)

Multicenter

Structured PICO

Population

249 patients with heart failure with reduced ejection fraction (HFrEF), including 75 with comorbid hypertension and diabetes, 97 with hypertension alone, and 77 HFrEF controls, evaluated via cardiac MRI and followed for a median of 34.3 months.

Exposure

Comorbid diabetes mellitus (DM) in hypertensive HFrEF patients

Comparator

Hypertensive HFrEF patients without DM, and HFrEF controls without HTN or DM

Outcome

Composite of HF readmission, all-cause mortality and heart transplantation

Main Result

Absolute Event Rate: -6.3% vs -8.6%

p-value: p=<0.001

Limitations

Retrospective and single-center design may introduce selection bias
Did not stratify HTN-HFrEF patients with comorbid DM according to the duration of diabetes
Myocardial fibrosis assessed by cardiac MRI late gadolinium enhancement or extracellular volume was not evaluated

Abstract

BACKGROUND: Hypertension (HTN) and diabetes mellitus (DM) are two common comorbidities of heart failure with reduced ejection fraction (HFrEF), each of which can cause right ventricular (RV) dysfunction. The aim of this study was to investigate the impact of DM on RV dysfunction and ventricular interdependence in hypertensive HFrEF patients via cardiac magnetic resonance imaging (MRI) feature tracking. METHODS: This study included 249 patients with HFrEF: 77 HFrEF controls, 97 with hypertensive HFrEF (HTN-HFrEF DM-) and 75 with hypertensive HFrEF and comorbid DM (HTN-HFrEF DM+). The cardiac MRI-derived biventricular global radial (GRS), circumferential (GCS) and longitudinal (GLS) peak strains were obtained and compared among the groups. Multivariable linear regression and mediation analyses were used to evaluate the effects of DM and left ventricular (LV) strain on RV strain. RESULTS: The biventricular GLS and GLS of segments 8, 9 and 14 of the interventricular septum (IVS) decreased gradually from the HFrEF control group to the HTN-HFrEF (DM-) group to the HTN-HFrEF (DM+) group (all P < 0.05). Patients with DM had even lower biventricular GCS and IVS strains in all directions in specific segments than did those without DM and the HFrEF controls (all P < 0.05). DM was independently associated with impaired RVGLS and RVGCS (both P < 0.05) in hypertensive HFrEF patients. The difference in RVGLS between the hypertensive HFrEF subgroups was partly mediated by LVGLS β = 0.80, 95% CI (0.39-1.31), and that of RVGCS was partly mediated by LVGCS β = 0.28, 95% CI (0.01-0.62). CONCLUSIONS: In hypertensive HFrEF patients, comorbid DM may have aggravated RV dysfunction and was an independent determinant of impaired RV strain. RV dysfunction might be directly affected by DM and partially mediated by LV strain through unfavorable ventricular independence.

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