Jasper Tromp1,2,3, Shir Lynn Lim4, Wan Ting Tay1, Tiew-Hwa Katherine Teng1, Chanchal Chandramouli1, Wouter Ouwerkerk1, Gupreet S Wander5, Jitendra P S Sawhney6, Jonathan Yap1, Michael R MacDonald7, Lieng Hsi Ling4,8, Naveed Sattar9, John J V McMurray9, A Mark Richards4,8,10,11, Inder Anand12, Carolyn S P Lam. 1. National Heart Centre Singapore, Singapore. 2. University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands. 3. Duke-NUS Medical School, Singapore. 4. Department of Cardiology, National University Heart Centre, Singapore. 5. Dayanand Medical College and Hospital, Ludhiana, India. 6. Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India. 7. Changi General Hospital, Singapore. 8. Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore. 9. Institute of Cardiovascular and Medical Sciences and School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, U.K. 10. Cardiovascular Research Institute, National University Health System, Singapore. 11. Christchurch Heart Institute, University of Otago, Christchurch, New Zealand. 12. Veterans Affairs Medical Center, Minneapolis, MN.
Abstract
OBJECTIVE: Microvascular complications are common among patients with diabetes mellitus (DM). The presence of heart failure (HF) is presumed to be due to macrovascular disease (typically HF with reduced ejection fraction [HFrEF] following myocardial infarction). We hypothesized that HF with preserved ejection fraction (HFpEF) in patients with DM may be a manifestation of microvascular disease compared with HFrEF. The objective of this study was to examine the prevalence and association with clinical outcome of microvascular complications in patients with HF and DM. RESEARCH DESIGN AND METHODS: We investigated the prevalence, association with clinical outcome, and cardiac structure and function of microvascular (neuropathy, nephropathy, and retinopathy) complications of DM in 2,800 prospectively enrolled participants with HF and DM (561 with HFpEF) from the Asian Sudden Cardiac Death In Heart Failure (ASIAN-HF) registry. RESULTS: A total of 601 (21.5%) participants with DM had microvascular complications. Participants with DM and any (one or more) microvascular complications were more likely to have HFpEF (odds ratio 1.70 [95% CI 1.15-2.50]; P = 0.008). Furthermore, the likelihood of having HFpEF increased with an increasing number of microvascular complications (P trend < 0.001). Microvascular complications were associated with more left ventricular (LV) hypertrophy and a greater reduction in quality of life in HFpEF than HFrEF (P interaction < 0.001 for all). Compared with participants with DM and without microvascular complications, the adjusted hazard ratio for the composite outcome of all-cause death or HF hospitalization was 1.35 (95% CI 1.04-1.76) for participants with DM and microvascular complications regardless of HF type (P interaction = 0.112). CONCLUSIONS: Diabetic microvascular disease is more common, and related to greater LV remodeling, more impairment of quality in life, and similar adverse outcomes, in participants with HFpEF compared with HFrEF. HFpEF may be a clinical manifestation of microvascular disease in DM.
OBJECTIVE: Microvascular complications are common among patients with diabetes mellitus (DM). The presence of heart failure (HF) is presumed to be due to macrovascular disease (typically HF with reduced ejection fraction [HFrEF] following myocardial infarction). We hypothesized that HF with preserved ejection fraction (HFpEF) in patients with DM may be a manifestation of microvascular disease compared with HFrEF. The objective of this study was to examine the prevalence and association with clinical outcome of microvascular complications in patients with HF and DM. RESEARCH DESIGN AND METHODS: We investigated the prevalence, association with clinical outcome, and cardiac structure and function of microvascular (neuropathy, nephropathy, and retinopathy) complications of DM in 2,800 prospectively enrolled participants with HF and DM (561 with HFpEF) from the Asian Sudden Cardiac Death In Heart Failure (ASIAN-HF) registry. RESULTS: A total of 601 (21.5%) participants with DM had microvascular complications. Participants with DM and any (one or more) microvascular complications were more likely to have HFpEF (odds ratio 1.70 [95% CI 1.15-2.50]; P = 0.008). Furthermore, the likelihood of having HFpEF increased with an increasing number of microvascular complications (P trend < 0.001). Microvascular complications were associated with more left ventricular (LV) hypertrophy and a greater reduction in quality of life in HFpEF than HFrEF (P interaction < 0.001 for all). Compared with participants with DM and without microvascular complications, the adjusted hazard ratio for the composite outcome of all-cause death or HF hospitalization was 1.35 (95% CI 1.04-1.76) for participants with DM and microvascular complications regardless of HF type (P interaction = 0.112). CONCLUSIONS:Diabetic microvascular disease is more common, and related to greater LV remodeling, more impairment of quality in life, and similar adverse outcomes, in participants with HFpEF compared with HFrEF. HFpEF may be a clinical manifestation of microvascular disease in DM.
Authors: Janusz Sadowski; Ryszard Targonski; Piotr Cyganski; Paulina Nowek; Magdalena Starek-Stelmaszczyk; Katarzyna Zajac; Judyta Juranek; Joanna Wojtkiewicz; Andrzej Rynkiewicz Journal: J Clin Med Date: 2022-06-27 Impact factor: 4.964
Authors: Navin Suthahar; Emily S Lau; Michael J Blaha; Samantha M Paniagua; Martin G Larson; Bruce M Psaty; Emelia J Benjamin; Matthew A Allison; Traci M Bartz; James L Januzzi; Daniel Levy; Laura M G Meems; Stephan J L Bakker; Joao A C Lima; Mary Cushman; Douglas S Lee; Thomas J Wang; Christopher R deFilippi; David M Herrington; Matthew Nayor; Ramachandran S Vasan; Julius M Gardin; Jorge R Kizer; Alain G Bertoni; Norrina B Allen; Ron T Gansevoort; Sanjiv J Shah; John S Gottdiener; Jennifer E Ho; Rudolf A de Boer Journal: J Am Coll Cardiol Date: 2020-09-22 Impact factor: 24.094
Authors: Barend W Florijn; Gideon B Valstar; Jacques M G J Duijs; Roxana Menken; Maarten J Cramer; Arco J Teske; Chahinda Ghossein-Doha; Frans H Rutten; Marc E A Spaanderman; Hester M den Ruijter; Roel Bijkerk; Anton Jan van Zonneveld Journal: Sci Rep Date: 2020-08-18 Impact factor: 4.379