Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry.
Cardiopulmonary exercise test
Chronic heart failure
Diabetes
Insulin resistance
Right ventricle
TOSCA
Journal
Cardiovascular diabetology
ISSN: 1475-2840
Titre abrégé: Cardiovasc Diabetol
Pays: England
ID NLM: 101147637
Informations de publication
Date de publication:
16 06 2022
16 06 2022
Historique:
received:
23
03
2022
accepted:
16
05
2022
entrez:
16
6
2022
pubmed:
17
6
2022
medline:
22
6
2022
Statut:
epublish
Résumé
Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance-IR or diabetes mellitus-T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF. Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D. Compared with EU and IR, T2D was associated with increased filling pressures (E/e'ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO The higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis. Trial registration ClinicalTrials.gov identifier: NCT023358017.
Sections du résumé
BACKGROUND
Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance-IR or diabetes mellitus-T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF.
METHODS
Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D.
RESULTS
Compared with EU and IR, T2D was associated with increased filling pressures (E/e'ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO
CONCLUSION
The higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis. Trial registration ClinicalTrials.gov identifier: NCT023358017.
Identifiants
pubmed: 35710369
doi: 10.1186/s12933-022-01543-3
pii: 10.1186/s12933-022-01543-3
pmc: PMC9204878
doi:
Substances chimiques
Insulins
0
Banques de données
ClinicalTrials.gov
['NCT02335801']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
108Investigateurs
A Cittadini
(A)
A M Marra
(AM)
M Arcopinto
(M)
R D'Assante
(R)
L Saccà
(L)
M G Monti
(MG)
R Napoli
(R)
M Matarazzo
(M)
F M Stagnaro
(FM)
L Piccioli
(L)
A Lombardi
(A)
V Panicara
(V)
M Flora
(M)
L Golia
(L)
V Faga
(V)
A Ruocco
(A)
D Della Polla
(D)
R Franco
(R)
A Schiavo
(A)
A Gigante
(A)
E Spina
(E)
M Sicuranza
(M)
F Monaco
(F)
M Apicella
(M)
C Miele
(C)
A G Campanino
(AG)
L Mazza
(L)
R Abete
(R)
A Farro
(A)
F Luciano
(F)
R Polizzi
(R)
G Ferrillo
(G)
M De Luca
(M)
G Crisci
(G)
F Giardino
(F)
M Barbato
(M)
A Salzano
(A)
B Ranieri
(B)
E Bossone
(E)
F Ferrara
(F)
V Russo
(V)
M Malinconico
(M)
R Citro
(R)
E Guastalamacchia
(E)
M Iacoviello
(M)
M Leone
(M)
V Triggiani
(V)
V A Giagulli
(VA)
F Cacciatore
(F)
C Maiello
(C)
C Amarelli
(C)
I Mattucci
(I)
G Limongelli
(G)
D Masarone
(D)
P Calabrò
(P)
R Calabrò
(R)
A D'Andrea
(A)
V Maddaloni
(V)
G Pacileo
(G)
R Scarafile
(R)
F Perticone
(F)
A Belfiore
(A)
A Sciacqua
(A)
A Cimellaro
(A)
P Perrone Filardi
(P)
L Casaretti
(L)
S Paolillo
(S)
P Gargiulo
(P)
A Mancini
(A)
A M R Favuzzi
(AMR)
C Di Segni
(C)
C Bruno
(C)
E Vergani
(E)
M Volterrani
(M)
R Massaro
(R)
O Vriz
(O)
F Grimaldi
(F)
R Castello
(R)
A Frigo
(A)
M R Campo
(MR)
M R Sorrentino
(MR)
P A Modesti
(PA)
D Malandrino
(D)
R Manfredini
(R)
A De Giorgi
(A)
F Fabbian
(F)
A Puzzo
(A)
L Ragusa
(L)
L Caliendo
(L)
L Carbone
(L)
A Frigiola
(A)
T Generali
(T)
F Giacomazzi
(F)
C De Vincentiis
(C)
A Ballotta
(A)
P Garofalo
(P)
G Malizia
(G)
S Milano
(S)
G Misiano
(G)
T Suzuki
(T)
M Z Israr
(MZ)
D Bernieh
(D)
S Cassambai
(S)
Y Yazaki
(Y)
L M Heaney
(LM)
K A Eagle
(KA)
H O Ventura
(HO)
A Colao
(A)
D Bruzzese
(D)
Informations de copyright
© 2022. The Author(s).
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