Coronary microvascular function is independently associated with left ventricular filling pressure in patients with type 2 diabetes mellitus

Kawata, Takayuki; Daimon, Masao; Miyazaki, Sakiko; Ichikawa, Ryoko; Maruyama, Masaki; Chiang, Shuo Ju; Ito, Chiharu; Sato, Fumihiko; Watada, Hirotaka; Daida, Hiroyuki

doi:10.1186/s12933-015-0263-7

Cited by 46 publications

(42 citation statements)

References 49 publications

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“…Coronary flow reserve, which reflects coronary microvascular function, correlated independently with echocardiographic measures of LV diastolic dysfunction in diabetics without evidence of CAD [23] and the presence of microvascular disease correlated independently with LA volume [24]. In keeping with this, we found that baseline clinical evidence of microvascular disease in noncardiac vascular territories independently predicted HF-CVD.…”

Section: Discussionsupporting

confidence: 69%

Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study

Halon¹,

Jubran²,

Rubinshtein³

et al. 2017

Cardiology

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Objectives: Predictive models for heart failure (HF) in heterogeneous populations have had limited success. We examined cardiac computed tomography angiography (CTA) predictors of HF or cardiovascular death (HF-CVD) in a prospective study of asymptomatic diabetics undergoing baseline assessment by CTA. Methods: The subjects (n = 735, aged 55-74 years, 51.2% women) had no clinical history of cardiovascular disease at study entry. Coronary artery calcium (CAC) score, CTA-defined coronary atherosclerosis, cardiac chamber volumes, and clinical data were collected and late outcome events recorded over 8.4 ± 0.6 years (range 7.3-9.3). Results: HF-CVD occurred in 41 (5.6%) subjects, with HF occurring mostly (19/23, 82.6%) in subjects without preceding myocardial infarction. Baseline univariate clinical outcome predictors of HF-CVD included older age (p = 0.027), the duration of diabetes (p = 0.004), HbA1c (p < 0.0001), microvascular disease (retinopathy, microalbuminuria) (p < 0.0001), and systolic blood pressure (p = 0.035). Baseline univariate CTA predictors included CAC score (p = 0.004), coronary stenosis (p = 0.047), and a CTA-defined left/right atrial (LA/RA) volume ratio >1 (p < 0.0001). Independent predictors were an LA/RA volume ratio >1, microvascular disease, and systolic blood pressure (model C-statistic 0.792, 95% CI 0.758-0.824). Measures of the extent of coronary artery disease (CAD) were not independent predictors of HF-CVD. Conclusions: In a low- to moderate-risk asymptomatic diabetic population, CTA LA enlargement (LA/RA volume ratio) but not the extent of CAD had independent prognostic value for HF-CVD in addition to the clinical variables.

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Section: Discussionsupporting

confidence: 69%

Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study

Halon¹,

Jubran²,

Rubinshtein³

et al. 2017

Cardiology

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“…A possible explanation for this finding could be elevated LV pressure, which is well described to be an early change in diastolic dysfunction. Coronary flow reserve has also been associated with LV filling pressure [18] in ObT2D which suggest a more sophisticated pathway of diastolic dysfunction. Additionally, the longitudinal (SRl E′ /SRl A′ ) and radial (Vr E′ /Vr A′ ) ratios depicted the change in the LA wall deformation, the passive conduit phase relative to the active phase of the LA.…”

Section: Discussionmentioning

confidence: 99%

Impact of obesity and epicardial fat on early left atrial dysfunction assessed by cardiac MRI strain analysis

Evin

Broadhouse

Callaghan

et al. 2016

Cardiovasc Diabetol

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Background: Diastolic dysfunction is a major cause of morbidity in obese individuals. We aimed to assess the ability of magnetic resonance imaging (MRI) derived left atrial (LA) strain to detect early diastolic dysfunction in individuals with obesity and type 2 diabetes, and to explore the association between cardiac adipose tissue and LA function.Methods: Twenty patients with obesity and T2D (55 ± 8 years) and nineteen healthy controls (48 ± 13 years) were imaged using cine steady state free precession and 2-point Dixon cardiovascular magnetic resonance. LA function was quantified using a feature tracking technique with definition of phasic longitudinal strain and strain rates, as well as radial motion fraction and radial velocities.Results: Systolic left ventricular size and function were similar between the obesity and type 2 diabetes and control groups by MRI. All patients except four had normal diastolic assessment by echocardiography. In contrast, measures of LA function using magnetic resonance feature tracking were uniformly altered in the obesity and type 2 diabetes group only. Although there was no significant difference in intra-myocardial fat fraction, Dixon 3D epicardial fat volume(EFV) was significantly elevated in the obesity and type 2 diabetes versus control group (135 ± 31 vs. 90 ± 30 mL/m 2 , p < 0.001). There were significant correlations between LA functional indices and both BMI and EFV (p ≤ 0.007).Conclusions: LA MRI-strain may be a sensitive tool for the detection of early diastolic dysfunction in individuals with obesity and type 2 diabetes and correlated with BMI and epicardial fat supporting a possible association between adiposity and LA strain.

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“…In addition to metabolic abnormalities, the diabetic heart displays major CHF-independent microvascular changes (eg, perivascular/subendothelial fibrosis, endothelial dysfunction, abnormal capillary permeability/density, microaneurysms, aberrant angiogenesis),2 highlighting likely contribution to associated remodelling. Indeed, in diabetics, impaired coronary microvascular function is linked with diastolic dysfunction,16 while microvascular complications predict cardiovascular disease,2 and retinopathy confers increased CHF risk 17. Similarly, systemic and tissue inflammation, observed in experimental/clinical diabetic CHF, is associated with endothelial dysfunction and may drive reduced coronary microvascular vasodilation in diastolic CHF 15 18.…”

Section: Cardiac Remodelling In Diabetesmentioning

confidence: 99%

Reactive oxygen species signalling in the diabetic heart: emerging prospect for therapeutic targeting

Wilson

Gill

Abudalo

et al. 2017

Heart

133

100

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Despite being first described 45 years ago, the existence of a distinct diabetic cardiomyopathy remains controversial. Nonetheless, it is widely accepted that the diabetic heart undergoes characteristic structural and functional changes in the absence of ischaemia and hypertension, which are independently linked to heart failure progression and are likely to underlie enhanced susceptibility to stress. A prominent feature is marked collagen accumulation linked with inflammation and extensive extracellular matrix changes, which appears to be the main factor underlying cardiac stiffness and subclinical diastolic dysfunction, estimated to occur in as many as 75% of optimally controlled diabetics. Whether this characteristic remodelling phenotype is primarily driven by microvascular dysfunction or alterations in cardiomyocyte metabolism remains unclear. Although hyperglycaemia regulates multiple pathways in the diabetic heart, increased reactive oxygen species (ROS) generation is thought to represent a central mechanism underlying associated adverse remodelling. Indeed, experimental and clinical diabetes are linked with oxidative stress which plays a key role in cardiomyopathy, while key processes underlying diabetic cardiac remodelling, such as inflammation, angiogenesis, cardiomyocyte hypertrophy and apoptosis, fibrosis and contractile dysfunction, are redox sensitive. This review will explore the relative contributions of the major ROS sources (dysfunctional nitric oxide synthase, mitochondria, xanthine oxidase, nicotinamide adenine dinucleotide phosphate oxidases) in the diabetic heart and the potential for therapeutic targeting of ROS signalling using novel pharmacological and non-pharmacological approaches to modify specific aspects of the remodelling phenotype in order to prevent and/or delay heart failure development and progression.

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Coronary microvascular function is independently associated with left ventricular filling pressure in patients with type 2 diabetes mellitus

Cited by 46 publications

References 49 publications

Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study

Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study

Impact of obesity and epicardial fat on early left atrial dysfunction assessed by cardiac MRI strain analysis

Reactive oxygen species signalling in the diabetic heart: emerging prospect for therapeutic targeting

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