What question did this study set out to answer?

To characterize cardiac morphological differences and determine proteomic signatures linked to myocardial fibrosis in hypertensive patients with and without diabetes mellitus.

March 29, 2023Open Access

Impact of Diabetes Mellitus on Myocardial Fibrosis in Patients with Hypertension: the REMODEL Study

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Why the study?

Patients with hypertension and diabetes have a worse prognosis than those with hypertension alone, prompting characterization of morphological differences by CMR and differentially expressed proteins associated with myocardial fibrosis.

Does concomitant diabetes mellitus increase myocardial fibrosis and adverse cardiac remodeling in patients with hypertension?

Key Points

To characterize cardiac morphological differences and determine proteomic signatures linked to myocardial fibrosis in hypertensive patients with and without diabetes mellitus.
Asymptomatic patients underwent cardiovascular magnetic resonance: 438 with hypertension alone (mean age 60±8 years; 59% male) and 167 age- and sex-matched patients with hypertension and diabetes (mean age 60±10 years; 64% male).
Late gadolinium enhancement evaluated replacement myocardial fibrosis, extracellular volume fraction measured diffuse fibrosis, and 184 serum proteins were analyzed using multiplex assays.
Replacement myocardial fibrosis occurred in 28% of patients with hypertension and diabetes compared to 16% of those with hypertension alone (P<0.001), despite similar left ventricular mass (P=0.344) and systolic blood pressure (P=0.086).
Patients with both hypertension and diabetes showed worse multi-directional strain across all measures (P<0.001) and elevated GDF-15 independently linked to fibrosis, accompanied by increased inflammatory and immune cell trafficking pathways.

Structured PICO

Does concomitant diabetes mellitus increase myocardial fibrosis and adverse cardiac remodeling in patients with hypertension?

Population

605 asymptomatic patients with essential hypertension (age ≥21 years). 438 with hypertension only (mean age 60±8, 59% male) and 167 age- and sex-matched patients with hypertension and diabetes mellitus (mean age 60±10, 64% male). Key exclusions: secondary causes of hypertension, ischemic heart disease, heart failure, previous cerebrovascular events, atrial fibrillation, and contraindications to gadolinium contrast and CMR.

Intervention

Concomitant diabetes mellitus (HTN/DM group)

Comparator

Hypertension only (HTN group)

Outcome

Morphological differences (replacement myocardial fibrosis, extracellular volume fraction) and differentially expressed serum proteins associated with myocardial fibrosissurrogate

In hypertensive patients, concomitant diabetes mellitus accelerates adverse cardiac remodeling and myocardial fibrosis, which is associated with distinct proteomic signatures of inflammation and immune activation.

Discussion

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Implication

Distinct CMR phenotypes and fibrosis-related proteins in HTN/DM are hypothesis-generating; leaves open validation before clinical use.

Cite This Study

Pua et al. (2023) studied this question.

synapsesocial.com/papers/6a906ae38ecb2c271c909813 https://doi.org/10.1101/2023.03.27.23287819

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Impact of Diabetes Mellitus on Myocardial Fibrosis in Patients with Hypertension: the REMODEL Study

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Impact of Diabetes Mellitus on Myocardial Fibrosis in Patients with Hypertension: the REMODEL Study

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Also Consider