학술논문
Impact of diabetes on remodelling, microvascular function and exercise capacity in aortic stenosis
Document Type
article
Author
David Gordon; Kai Hogrefe; Thomas Yates; Anvesha Singh; Leong L Ng; Gerry P McCann; Lei Zhao; Emer M Brady; Hui Xue; John Greenwood; Peter Kellman; Gaurav S Gulsin; Christopher D Steadman; Dana Dawson; Michael Jerosch-Herold; Aseel Alfuhied; Saadia Aslam; Damian Kelly; J Ranjit Arnold; Jian L Yeo; Abhishek Dattani; Marko Banovic; Philippe Costet; Mary Ellen Cvijic; Christina Ebert; Laura Liu; Kushan Gunawardhana; Ching-Pin Chang
Source
Open Heart, Vol 10, Iss 2 (2023)
Subject
Language
English
ISSN
2053-3624
Abstract
Objective To characterise cardiac remodelling, exercise capacity and fibroinflammatory biomarkers in patients with aortic stenosis (AS) with and without diabetes, and assess the impact of diabetes on outcomes.Methods Patients with moderate or severe AS with and without diabetes underwent echocardiography, stress cardiovascular magnetic resonance (CMR), cardiopulmonary exercise testing and plasma biomarker analysis. Primary endpoint for survival analysis was a composite of cardiovascular mortality, myocardial infarction, hospitalisation with heart failure, syncope or arrhythmia. Secondary endpoint was all-cause death.Results Diabetes (n=56) and non-diabetes groups (n=198) were well matched for age, sex, ethnicity, blood pressure and severity of AS. The diabetes group had higher body mass index, lower estimated glomerular filtration rate and higher rates of hypertension, hyperlipidaemia and symptoms of AS. Biventricular volumes and systolic function were similar, but the diabetes group had higher extracellular volume fraction (25.9%±3.1% vs 24.8%±2.4%, p=0.020), lower myocardial perfusion reserve (2.02±0.75 vs 2.34±0.68, p=0.046) and lower percentage predicted peak oxygen consumption (68%±21% vs 77%±17%, p=0.002) compared with the non-diabetes group. Higher levels of renin (log10renin: 3.27±0.59 vs 2.82±0.69 pg/mL, p