Key result
Type 2 diabetes in patients with aortic stenosis was associated with significantly reduced left ventricular midwall fractional shortening (11.9% vs 14.1%) and lower systemic arterial compliance.
Why the study?
The effects of coexisting T2DM on circumferential LV midwall systolic function and large artery properties in patients with AS had not been reported.
Does concomitant type 2 diabetes impair left ventricular midwall systolic function and systemic arterial compliance in patients with moderate or severe aortic stenosis?
Cross-Sectional (n=130)
No
Does concomitant type 2 diabetes impair left ventricular midwall systolic function and systemic arterial compliance in patients with moderate or severe aortic stenosis?
Absolute Event Rate: 11.9% vs 14.1%
p-value: p=0.001
In patients with moderate or severe aortic stenosis, concomitant type 2 diabetes is associated with reduced systemic arterial compliance and impaired left ventricular midwall systolic function despite preserved ejection fraction.
T2DM-associated midwall impairment in aortic stenosis should not yet change practice; leaves open effects on progression and outcomes.
BACKGROUND: Degenerative aortic stenosis (AS), a disease of the elderly, frequently coexists with concomitant diseases, including type 2 diabetes (T2DM) which amplifies the cardiovascular (CV) risk. T2DM affects left ventricular (LV) structure and function via hemodynamic and metabolic factors. In concentric LV geometry, typical for AS, indices of LV midwall mechanics are better estimates of LV function than ejection fraction (EF). Effects of T2DM coexisting with AS on circumferential LV midwall systolic function and large artery properties have not been reported so far. Our aim was to compare characteristics of AS patients with and without T2DM, with a focus on LV midwall systolic function and arterial compliance. METHODS: Medical records of 130 electively hospitalized patients with moderate or severe isolated degenerative AS were retrospectively analyzed. Exclusion criteria included clinical instability, atrial fibrillation, coronary artery disease and relevant non-cardiac diseases. From in-hospital echocardiography and blood pressure, we calculated LV midwall fractional shortening (mwFS), circumferential end-systolic LV wall stress (cESS) and valvulo-arterial impedance (Zva), estimates of LV afterload, as well as systemic arterial compliance. RESULTS: per mmHg, p = 0.01). mwFS (11.9 ± 3.9 vs. 14.1 ± 3.7%, p = 0.001), but not EF (51 ± 14 vs. 54 ± 13%, p = n.s.), was reduced in T2DM. mwFS and cESS were inversely interrelated in patients both with (r = - 0.59, p < 0.001) and without T2DM (r = - 0.53, p < 0.001) By multiple regression, higher cESS (p < 0.001) and T2DM (p = 0.02) were independent predictors of depressed mwFS. CONCLUSIONS: In AS, coexistent T2DM appears associated with reduced systemic arterial compliance and LV dysfunction at the midwall level, corresponding to slightly depressed myocardial contractility.
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Czestkowska et al. (2019) conducted a cross-sectional in Moderate or severe isolated degenerative aortic stenosis (n=130). Type 2 diabetes vs. No diabetes was evaluated on Left ventricular midwall fractional shortening (mwFS) (p=0.001). Type 2 diabetes in patients with aortic stenosis was associated with significantly reduced left ventricular midwall fractional shortening (11.9% vs 14.1%) and lower systemic arterial compliance.
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